Biomechanical Value of a Protective Proximal Humeral Cerclage in Reverse Total Shoulder Arthroplasty

Michel, P.; Katthagen, J. Christoph; Schliemann, Benedikt; Wilkens, Sina; Frank, André Günder; Heilmann, L.; Dyrna, Felix; Raschke, Michael J.

doi:10.3390/jcm10194600

Cited by 3 publications

(2 citation statements)

References 39 publications

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“…In a case series on patients undergoing RTSA for degenerative diseases, Kriechling et al managed intraoperative nondisplaced calcar fracture with either suture or metal cerclage achieving fracture healing without any sign of stem subsidence or loosening [ 34 ]. Moreover, as shown with a biomechanical study, the protection of the metaphyseal calcar region with steel wire cerclage results in an increased energy needed to make the fracture progress distally to the cerclage [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty with a Cementless and Metaphyseal Stem Fixation Is a Viable Option for the Treatment of Proximal Humeral Fractures with Calcar Involvement

Garofalo

Fontanarosa

Lassandro

et al. 2023

JCM

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Background: The purpose of the study was to evaluate the suitability of reverse total shoulder arthroplasty (RTSA) with a cementless and metaphyseal stem fixation as a treatment for complex proximal humeral fractures (PHFs) with a calcar fragment when this may be fixed with a steel wire cerclage. Clinical and radiographic outcomes were compared with the same RTSA for PHFs without a calcar fragment at a minimum of five-year follow-up. Methods: A retrospective analysis was performed on acute PHFs “with a medial calcar fragment” (group A) and “without a calcar fragment” (group B) treated with a RTSA and cementless metaphyseal stem fixation. Results: At an average follow-up of 6.7 years (5–7.8 years), no statistical difference was observed comparing group A (18 patients) to group B (50 patients) for active anterior elevation (141 ± 15° vs. 145 ± 10°, p = 0.67), active external rotation ER1 (49 ± 15° vs. 53 ± 13°, p = 0.55), and active internal rotation (5 ± 2 vs. 6 ± 2, p = 0.97). Similarly, a comparison of ASES score (89.2 ± 10 vs. 91.6 ± 9, p = 0.23) and Simple Shoulder Test score (91.1 ± 11 vs. 90.4 ± 10, p = 0.49) revealed no significant difference. Conclusion: RTSA with a cementless and metaphyseal stem fixation represents a safe and feasible treatment for complex PHFs with a medial calcar fragment when this may be fixed with a steel wire cerclage.

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Section: Discussionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty with a Cementless and Metaphyseal Stem Fixation Is a Viable Option for the Treatment of Proximal Humeral Fractures with Calcar Involvement

Garofalo

Fontanarosa

Lassandro

et al. 2023

JCM

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“…It has been shown that the increasing need for the strengthening support of the cerclage constructs mainly relies on the aging patient population with increasing numbers of periprosthetic fractures as one major indication [ 5 , 9 ]. Furthermore, cerclages are nowadays not only used for fracture treatment but may also provide a protective character for primary arthroplasty implantation, especially in patients with reduced bone quality [ 10 , 11 ]. Lastly, the application of cerclage constructs can help to manage reduction and serve as primary stabilization for complex fractures, outlining the variety of indications [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Cerclage performance analysis – a biomechanical comparison of different techniques and materials

Hägerich

Dyrna

Katthagen

et al. 2022

BMC Musculoskelet Disord

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Background Wire cerclages play a fundamental role in fracture fixation. With an increasing variety of designs being commercially available the question arises which cerclage should be used. This study investigates the biomechanical properties of metallic and non-metallic cerclages and their different application-types. Furthermore, potential influence of muscular interposition between bone and cerclage constructs was tested. Methods Samples of the following four different cerclage types were tested on 3D printed models of human humeri as well as on human cadaveric humeri with and without muscular interposition: Titanium Cable Cerclage (CC), Steel Wire Cerclage (SWC), Suture Tape (ST), Suture Tape Cerclage (STC) with both single- (sSTC) and double-loop application (dSTC). A preinstalled self-locking mechanism secured by the provided tensioner in the STCs being the main difference to the STs. Cyclic loading was performed to 1 kN and then linearly to a maximum load of 3 kN. Statistical analysis was performed using either one-way ANOVA and post-hoc Tukey or Kruskal–Wallis and post-hoc Dunn test depending on normalization of data (p < 0.05). Results Whilst all cerclage options could withstand high loads during failure testing, only within the CC and dSTC group, all samples reached the maximal testing load of 3000 N without any failure. The SWC reached 2977.5 ± 63.6 N, the ST 1970.8 ± 145.9 N, and the sSTC 1617.0 ± 341.6 N on average. Neither muscular interposition nor bone quality showed to have a negative influence on the biomechanical properties of the cerclage constructs, presenting no significant differences. Conclusion All tested cerclage constructs produce reliable stability but differ in their resulting compression forces, in a simplified fracture model. Therefore, non-metallic cerclage alternatives can provide similar stability with less compression and stiffness to metallic cable constructs, but they may offer several advantages and could possibly provide future benefits. Especially, by offering more elasticity without losing overall stability, may offer a biologic benefit. Installing any cerclage constructs should be performed carefully, especially if poor bone quality is present, as the tightening process leads to high forces on the construct.

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Impact of Prophylactic Cerclage Location on Femoral Fracture Propagation: A Biomechanical Study

Han,

Reddy,

Lanfermeijer

et al. 2024

Journal of Orthopaedic Trauma

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Objectives: Prophylactic cerclage cables are often placed intraoperatively about a fracture to prevent propagation. However, biomechanical data supporting optimal cable placement location is lacking. The objective of this study was to evaluate the impact of prophylactic cerclage placement location on the propagation of femoral shaft fractures. Methods: The diaphysis of fourteen fresh frozen cadaveric femora were included. Volumetric bone mineral density (BMD) in the femoral shaft was obtained from quantitative computed tomography scans. For each specimen, a 5-mm longitudinal fracture was created proximally to simulate a pre-existing fracture. Following reaming of the femoral canal, a 3° tapered wedge was advanced with an MTS machine at 0.2 mm/s until failure. The tests were conducted with a CoCr cable placed at varying distances (5mm, 10mm, 15mm, 20mm, and cableless) from the distal tip of the initial fracture. A compression loadcell was used to measure the cable tension during the tests. The axial force, displacement, and cable tension were monitored for comparison between groups. Results: In the cableless group, the mean force needed to propagate the fracture was 1017.8±450.3 N. With the addition of a cable at 5mm below the fracture, the failure force nearly doubled to 1970.4±801.1 N (p<0.001). This also led to significant increases in stiffness (p=0.006) and total work (p=0.001) when compared to the control group. In contrast, in the 15 and 20mm groups, there were no significant changes in the failure force, stiffness, and total work as compared to the control group (p>0.05). Conclusions: Propagation of femoral shaft fracture was effectively resisted when a prophylactic cable was placed within 5mm from the initial fracture, whereas cables placed more than 10mm below the initial fracture were not effective in preventing fracture propagation.

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Biomechanical Value of a Protective Proximal Humeral Cerclage in Reverse Total Shoulder Arthroplasty

Cited by 3 publications

References 39 publications

Reverse Total Shoulder Arthroplasty with a Cementless and Metaphyseal Stem Fixation Is a Viable Option for the Treatment of Proximal Humeral Fractures with Calcar Involvement

Reverse Total Shoulder Arthroplasty with a Cementless and Metaphyseal Stem Fixation Is a Viable Option for the Treatment of Proximal Humeral Fractures with Calcar Involvement

Cerclage performance analysis – a biomechanical comparison of different techniques and materials

Impact of Prophylactic Cerclage Location on Femoral Fracture Propagation: A Biomechanical Study

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