Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus

Zha, Yejun; Hua, Kehan; Huan, Yong; Chen, Chen; Sun, Weitong; Ji, Shangwei; Xiao, Dan; Gong, Maoqi; Jiang, Xieyuan

doi:10.1016/j.injury.2022.10.025

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…These better results obtained with a parallel configuration may be due to the more favorable space orientation in the plates, which are positioned parallel to each other and preferably in relation to the direction of the acting force (larger cross-sectional dimension of the plates set parallel to the plane of the force action). This effect is consistent with the results presented by Zha et al [28]. It is also worth noting that the parallel arrangement of the plates allows for the use of maximum-length screws connecting the plates to as many bone fragments as possible, which additionally reduces their mutual displacement.…”

Section: Discussionsupporting

confidence: 91%

“…It seems that the biomechanical studies did not encompass all clinically important aspects of the problem. Ambiguities in the assessment of plate configurations may largely result from limitations of the testing method, such as oversimplified loading conditions (for example, only axial or bending loadings) [27,28]. The other problem is the lack of realistic analysis of interfragmentary movement in multi-comminuted fractures and the assessment of fixation only on the basis of global stiffness [21,27].…”

Section: Introductionmentioning

confidence: 99%

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Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

Kruszewski,

Piszczatowski,

Piekarczyk

et al. 2024

JCM

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Background: Multi-comminuted, intra-articular fractures of the distal humerus still pose a challenge to modern orthopedics due to unsatisfactory treatment results and a high percentage (over 50%) of postoperative complications. When surgical treatment is chosen, such fractures are fixed using two plates with locking screws, which can be used in three spatial configurations: either parallel or one of two perpendicular variants (posterolateral and posteromedial). The evaluation of the fracture healing conditions for these plate configurations is unambiguous. The contradictions between the conclusions of biomechanical studies and clinical observations were the motivation to undertake a more in-depth biomechanical analysis aiming to indicate the weak points of two-plate fracture stabilization. Methods: Research was conducted using the finite element method based on an experimentally validated model. Three variants of distal humerus fracture (Y, λ, and H) were fixed using three different plate configurations (parallel, posterolateral, and posteromedial), and they were analyzed under six loading conditions, covering the whole range of flexion in the elbow joint (0–145°). A joint reaction force equal to 150 N was assumed, which corresponds with holding a weight of 1 kg in the hand. The biomechanical conditions of bone union were assessed based on the interfragmentary movement (IFM) and using criteria formulated by Steiner et al. Results: The IFMs were established for particular regions of all of the analyzed types of fracture, with distinction to the normal and tangential components. In general, the tangential component of IFM was greater than normal. A strong influence of the elbow joint’s angular position on the IFM was observed, with excessive values occurring for flexion angles greater than 90°. In most cases, the smallest IFM values were obtained for the parallel plaiting, while the greatest values were obtained for the posteromedial plating. Based on IFM values, fracture healing conditions in particular cases (fracture type, plate configuration, loading condition, and fracture gap localization) were classified into one of four groups: optimal bone union (OPT), probable union (PU), probable non-union (PNU), and non-union (NU). Conclusions: No plating configuration is able to ensure distal humerus fracture union when the full elbow flexion is allowed while holding a weight of 1 kg in the hand. However, flexion in the range of 0–90° with such loadings is acceptable when using parallel plating, which is a positive finding in the context of the early rehabilitation process. In general, parallel plating ensures better conditions for fracture healing than perpendicular plate configurations, especially the posteromedial version.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

Kruszewski,

Piszczatowski,

Piekarczyk

et al. 2024

JCM

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“…Double plating without augmentation screws versus single plating plus a transfracture lag screw for IAFs showed greater axial, bending, and torsional stiffness, as well as more bending strength, but may or may not achieve higher axial strength [ 48 , 57 ]. Double versus single plating of EAFs almost always exhibited less fracture motion, lower stress (i.e., bone and plate), higher stiffness (i.e., axial, bending, and torsion), and/or greater strength (i.e., bending and torsion) [ 16 , 18 , 62 , 76 – 79 ].…”

Section: Resultsmentioning

confidence: 99%

“…For IAFs, parallel versus perpendicular double plating had less fracture motion [ 41 – 43 , 54 , 55 ]; smaller bone, plate, and/or screw stress [ 35 , 40 ]; longer fatigue life [ 54 ]; higher axial, bending, and/or torsional stiffness [ 32 , 35 , 36 , 40 , 42 , 43 , 46 , 49 – 51 , 54 – 57 ]; and greater axial, bending, and/or torsional strength [ 32 , 43 , 46 , 49 , 51 , 56 , 57 ]. However, some comparisons showed that parallel versus perpendicular double plating had lower or equivalent stiffness and strength, leading to more fracture motion and plate stress, likely due to different study protocols [ 32 , 36 , 40 , 43 , 45 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review

Zdero,

Brzozowski,

Schemitsch

2024

BioMed Research International

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The goal of this article was to review studies on distal humerus fracture plates (DHFPs) to understand the biomechanical influence of systematically changing the plate or screw variables. The problem is that DHFPs are commonly used surgically, although complications can still occur, and it is unclear if implant configurations are always optimized using biomechanical criteria. A systematic search of the PubMed database was conducted to identify English‐language biomechanical optimization studies of DHFPs that parametrically altered plate and/or screw variables to analyze their influence on engineering performance. Intraarticular and extraarticular fracture (EAF) data were separated and organized under commonly used biomechanical outcome metrics. The results identified 52 eligible DHFP studies, which evaluated various plate and screw variables. The most common plate variables evaluated were geometry, hole type, number, and position. Fewer studies assessed screw variables, with number and angle being the most common. However, no studies examined nonmetallic materials for plates or screws, which may be of interest in future research. Also, articles used various combinations of biomechanical outcome metrics, such as interfragmentary fracture motion, bone, plate, or screw stress, number of loading cycles to failure, and overall stiffness (Os) or failure strength (Fs). However, no study evaluated the bone stress under the plate to examine bone “stress shielding,” which may impact bone health clinically. Surgeons treating intraarticular and extraarticular distal humerus fractures should seriously consider two precontoured, long, thick, locked, and parallel plates that are secured by long, thick, and plate‐to‐plate screws that are located at staggered levels along the proximal parts of the plates, as well as an extra transfracture plate screw. Also, research engineers could improve new studies by perusing recommendations in future work (e.g., studying alternative nonmetallic materials or “stress shielding”), clinical ramifications (e.g., benefits of locked plates), and study quality (e.g., experimental validation of computational studies).

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“…Consequently, this allows for the mobility of neighboring joints while ensuring proper alignment and healing of the fractured bone. To ensure sufficient stability and support bone functionality, DCPs must be placed against the periosteum (the tissue covering the outer surface of bones) [14][15][16][17]. However, this requirement raises a crucial issue regarding the cortical bone's porosity at the implant site due to limited blood supply.…”

Section: Introductionmentioning

confidence: 99%

Extra-Articular Distal Humerus Plate 3D Model Creation by Using the Method of Anatomical Features

Vitković,

Stojković,

Korunović

et al. 2023

Materials

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Proper fixation techniques are crucial in orthopedic surgery for the treatment of various medical conditions. Fractures of the distal humerus can occur due to either high-energy trauma with skin rupture or low-energy trauma in osteoporotic bone. The recommended surgical approach for treating these extra-articular distal humerus fractures involves performing an open reduction and internal fixation procedure using plate implants. This surgical intervention plays a crucial role in enhancing patient recovery and minimizing soft tissue complications. Dynamic Compression Plates (DCPs) and Locking Compression Plates (LCPs) are commonly used for bone fixation, with LCP extra-articular distal humerus plates being the preferred choice for extra-articular fractures. These fixation systems have anatomically shaped designs that provide angular stability to the bone. However, depending on the shape and position of the bone fracture, additional plate bending may be required during surgery. This can pose challenges such as increased surgery time and the risk of incorrect plate shaping. To enhance the accuracy of plate placement, the study introduces the Method of Anatomical Features (MAF) in conjunction with the Characteristic Product Features methodology (CPF). The utilization of the MAF enables the development of a parametric model for the contact surface between the plate and the humerus. This model is created using specialized Referential Geometrical Entities (RGEs), Constitutive Geometrical Entities (CGEs), and Regions of Interest (ROI) that are specific to the human humerus bone. By utilizing this anatomically tailored contact surface model, the standard plate model can be customized (bent) to precisely conform to the distinct shape of the patient’s humerus bone during the pre-operative planning phase. Alternatively, the newly designed model can be fabricated using a specific manufacturing technology. This approach aims to improve geometrical accuracy of plate fixation, thus optimizing surgical outcomes and patient recovery.

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Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus

Cited by 6 publications

References 26 publications

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review

Extra-Articular Distal Humerus Plate 3D Model Creation by Using the Method of Anatomical Features

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