International Orthopaedics

, Volume 41, Issue 7, pp 1471–1480 | Cite as

Numerical investigation of fracture impaction in proximal humeral fracture fixation with locking plate and intramedullary nail

  • Yen-Nien Chen
  • Chih-Wei Chang
  • Chia-Wei Lin
  • Chih-Wei Wang
  • Yao-Te Peng
  • Chih-Han Chang
  • Chun-Ting Li
Original Paper



Fracture impaction is a surgical technique used to support the fractured humerus with locking plate or intramedullary nail when treating proximal humeral fractures. However, few studies have investigated the mechanical difference between fracture impaction with locking plate and with intramedullary nail. The mechanism of fracture impaction to increase stability is still unclear. The aim of this study was to use numerical methods to compare the biomechanical effect of treating proximal humeral fracture.


Six different humerus models, including intact and fractured humeri with various fixation patterns were used in this study. Fracture impaction was simulated by moving the distal fragment of the humeral shift upwards directly until touching the inferior surface of the proximal fragment. We also considered both poor- and normal-quality bone in the simulation.


Results confirmed that fracture impaction increases fracture stabilityand decreases peak stress in both implant and bone. Also, fracture impaction and plating with medial shift of the humeral shaft provides the highest stability. The metallic implant shared loading with the bone in the impacted models, while implants sustained all the loading alone in the nonimpacted models.


Based on the results, the technique of fracture impaction is suggested for both nail and plate to reduce stresses on bone and implants and to increase structural stability. Furthermore, impaction with medial shift of the humeral shaft with plate is found to achieve the highest stability when treating proximal humeral fractures.


Proximal humeral fracture Fracture impaction Medial shift of humeral shaft Locking plate Intramedullary nail Finite element method 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Yen-Nien Chen
    • 1
  • Chih-Wei Chang
    • 1
    • 2
    • 3
  • Chia-Wei Lin
    • 4
  • Chih-Wei Wang
    • 5
  • Yao-Te Peng
    • 1
    • 6
  • Chih-Han Chang
    • 1
  • Chun-Ting Li
    • 7
  1. 1.Department of BioMedical EngineeringNational Cheng Kung UniversityTainan CityTaiwan
  2. 2.Department of Orthopedics, College of MedicineNational Cheng Kung UniversityTainan CityTaiwan
  3. 3.Department of OrthopedicsNational Cheng Kung University Hospital, Collage of Medicine, National Cheng Kung UniversityTainan CityTaiwan
  4. 4.Orthopedic Department of Taichung Tzu Chi General HospitalTaichung CityTaiwan
  5. 5.Department of Mechanical EngineeringUniversity of WashingtonSeattleUSA
  6. 6.Metal Industries Research & Development CentreKaohsiung CityTaiwan
  7. 7.Graduate Institute of Mechatronic System EngineeringNational University of TainanTainan CityTaiwan

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