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Comparison of fibula strut and calcium phosphate cement augmentation of the medial buttress in 2-part proximal humerus fractures reconstruction: a biomechanical study

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A Correction to this article was published on 18 January 2022

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Abstract

Purpose

Augmentation strategies for surgical fixation of proximal humerus fractures (PHF) are available to address their relatively high failure rate. The purpose of this study was to compare two medial-buttress augmentation strategies for PHF fixation.

Methods

A two-part PHF model with loss of medial buttress was created in 16 synthetic bones. The PHFs were fixed with locking plates and either calcium phosphate cement (CPC) or fibula strut (FS) augmentation. After cadaveric validations, the fixation constructs were subjected to nondestructive axial compression tests, followed by a cyclic test. Construct stiffness and angular displacement of the humerus head were recorded.

Results

Humeral head angular displacement was statistically greater in the CPC group than in the FS group at the applied force of 300 N and higher (p < 0.05). Axial stiffness was statistically greater in the FS fixation group than in the CPC group at initial and final phases of cyclic loading protocol (p < 0.05).

Conclusions

In an osteoporotic cadaveric model of a 2-part PHF with loss of a medial buttress, locked plate constructs augmented with FS have a higher resistance to varus collapse compared to those augmented with CPC.

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References

  1. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697

    Article  Google Scholar 

  2. Hintermann B, Trouillier HH, Schafer D (2000) Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br 82:1107–1112

    Article  CAS  Google Scholar 

  3. Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91(6):1320–1328

    Article  Google Scholar 

  4. Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288

    Article  Google Scholar 

  5. Seebeck J, Goldhahn J, Städele H, Messmer P, Morlock MM, Schneider E (2004) Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws. J Orthop Res 22:1237–1242

    Article  CAS  Google Scholar 

  6. Chow RM, Begum F, Beaupre LA, Carey JP, Adeeb S, Bouliane MJ (2011) Proximal humeral fracture fixation: locking plate construct±intramedullary fibular allograft. J Shoulder Elb Surg 21(7):894–901

    Article  Google Scholar 

  7. Egol KA, Sugi MT, Ong CC et al (2012) Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures. J Shoulder Elb Surg 21:741–748

    Article  Google Scholar 

  8. Gardner M, Weil Y, Barker J, Kelly B, Helfet D, Lorich D (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185–191

    Article  Google Scholar 

  9. Gradl G, Knobe M, Stoffel M et al (2013) Biomechanical evaluation of locking plate fixation of proximal humeral fractures augmented with calcium phosphate cement. J Orthop Trauma 27:399–404

    Article  Google Scholar 

  10. Hast MW, Chin M, Schmidt EC, Sanville J, Van Osten GK, Mehta S (2020) Mechanical effects of bone substitute and far-cortical locking techniques in 2-part proximal humerus fracture reconstruction: a cadaveric study. J Orthop Trauma 34:4

    Article  Google Scholar 

  11. Mathison C, Chaudhary R, Beaupre L, Reynolds M, Adeeb S, Bouliane M (2010) Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft. Clin Biomech (Bristol Avon) 25:642–646

    Article  Google Scholar 

  12. Kwon BK, Goertzen DJ, O’Brien PJ, Broekhuyse HM, Oxland TR (2002) Biomechanical evaluation of proximal humeral fracture fixation supplemented with calcium phosphate cement. J Bone Joint Surg Am 84(6):951–961

    Article  Google Scholar 

  13. Schliemann B, Seifert R, Rosslenbroich SB, Theisen C, Wähnert D, Raschke MJ, Weimann A (2015) Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures. J Shoulder Elb Surg 24:1968–1973. https://doi.org/10.1016/j.jse.2015.06.028

    Article  Google Scholar 

  14. Elfar J, Stanbury S, Menorca RMG, Reed JD (2014) Composite bone models in orthopaedic surgery research and education. J Am Acad Orthop Surg 22(2):111–120. https://doi.org/10.5435/JAAOS-22-02-111

    Article  Google Scholar 

  15. Bae JH, Oh JK, Chon CS, Oh CW, Hwang JH, Yoon YC (2011) The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. Bone Joint J 93(7):937–4

    Google Scholar 

  16. Zhao L, Qi YM, Yang L, Wang GR, Zheng SN, Wang Q, Liang B, Jiang CZ (2019) Comparison of the effects of proximal humeral internal locking system (PHILOS) alone and PHILOS combined with fibular allograft in the treatment of neer three- or four-part proximal humerus fractures in the elderly. Department of orthopaedic surgery, Nanjing first hospital, Nanjing medical university, Nanjing, China: orthopaedic surgery published by Chinese orthopaedic association and John Wiley & Sons, Australia Ltd

  17. Jung WB, Moon ES, Kim SK, Kovacevic D, Kim MS (2013) Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate? BMC Musculoskelet Disord 14:102

    Article  Google Scholar 

  18. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(1):S1–S170

    Article  Google Scholar 

  19. Brianza S, Plecko M, Gueorguiev B, Windolf M, Schwieger K (2010) Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model. Clin Biomech 25:886–892

    Article  Google Scholar 

  20. Rusimov L, Zderic I, Ciric D, Barcik JP, Enchev D, Rashkov M, Hadzhinikolova M, Geoff R, Gueorguiev B, Baltov A (2018) Does supplemental intramedullary grafting increase stability of plated proximal humerus fractures? J Orthop Trauma. https://doi.org/10.1097/BOT.0000000000001376

    Article  Google Scholar 

  21. Katthagen JC, Schwarze M, Meyer-Kobbe J, Voigt C, Hurschler C, Lill H (2014) Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures. Clin Biomech 29:735–741

    Article  Google Scholar 

  22. Rothstock S, Plecko M, Kloub M, Schiuma D, Windolf M, Gueorguiev B (2012) Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model. Clin Biomech (Bristol, Avon) 27(7):686–691

    Article  Google Scholar 

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Funding

OTA resident grant. This study was funded by the Orthopaedic Trauma Association (OTA), USA (Grant 254: OTA Resident Research Grant; UCSF Grant#: A126762; PI: Austin Pitcher, MD).

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Authors and Affiliations

  1. University of California, San Francisco, USA

    Dmitry Pokhvashchev, Riley Knox, Matthew Herring, Safa Herfat & Meir Tibrin Marmor

Authors
  1. Dmitry Pokhvashchev
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  2. Riley Knox
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  3. Matthew Herring
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  4. Safa Herfat
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  5. Meir Tibrin Marmor
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Contributions

P. Dmitry, MD, PhD–data analysis, manuscript preparation. R. Knox, BS–data analysis, biomechanical testing, manuscript preparation. M. Herring, MD–biomechanical testing, study design, manuscript preparation. S. Herfat, PhD–data analysis, biomechanical testing, study design, manuscript preparation. M. Tibrin Marmor, MD–study idea/conception, biomechanical testing, study design, manuscript preparation.

Corresponding author

Correspondence to Dmitry Pokhvashchev.

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Conflict of interest

The authors declare that they have no conflicts of interests or competing interests. Author Pokhvashchev Dmitry declares that he has no conflict of interest. Author Riley Knox declares that he has no conflict of interest. Author Matthew Herring declares that he has no conflict of interest. Author Safa Herfat declares that he has no conflict of interest. Author Meir Tibrin Marmor declares that he has no conflict of interest.

Ethical approval

Biomechanics study IRB exam. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The original online version of this article was revised: The first and last names of the few authors have been switched in the author names, Authors’ contribution section and Conflict of interest section.

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Pokhvashchev, D., Knox, R., Herring, M. et al. Comparison of fibula strut and calcium phosphate cement augmentation of the medial buttress in 2-part proximal humerus fractures reconstruction: a biomechanical study. Eur J Orthop Surg Traumatol 33, 67–72 (2023). https://doi.org/10.1007/s00590-021-03147-1

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  • DOI: https://doi.org/10.1007/s00590-021-03147-1

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