Computerized Virtual Surgery Planning for ORIF of Proximal Humeral Fractures

Abstract

The authors evaluated the effectiveness of computerized virtual planning for open reduction and internal fixation (ORIF) of proximal humeral fractures. Between June 2011 and July 2013, a total of 46 patients with proximal humeral fractures were included in the current study. Preoperatively, fracture data were obtained via computed tomography (CT) reconstruction. Based on the dataset obtained from CT scanning, the 3-dimensional model of fractures was constructed and virtual segmentation, restoration, and internal fixation were performed. All eligible cases were treated by ORIF with locking plates. Intraoperatively, operative time, blood loss, and fluoroscope frequency were recorded. Postoperatively, the curative effect was evaluated by quality of fracture restoration reconstruction and plate position. In addition, fracture healing time and complications were recorded in the follow-up period. Average operative time was 85.6 minutes, and intraoperative blood loss ranged from 60 to 150 mL. Postoperatively, 1 patient experienced avascular necrosis, and no cases of screw penetration or screw loosening were observed. The coincidence rate of plate position was 91.3% according to height and 95.7% based on the position of the intertubercular sulcus and greater tuberosity. At the end of the follow-up period, mean shoulder function score was 83.9 (range, 58-96). Eighty-seven percent of patients had an excellent or good outcome. Computerized virtual planning facilitated ORIF and showed good results for patients with complex proximal humeral fractures. It may be a favorable option for treating fractures of the proximal humerus.

Reproducibility of three dimensional digital preoperative planning for the osteosynthesis of distal radius fractures

“…A precise preoperative plan is necessary for good postoperative outcomes. Three‐dimensional imaging methods for planning in trauma surgery were recently developed using CT scanning …”

“…Three-dimensional imaging methods for planning in trauma surgery were recently developed using CT scanning. [14][15][16] In addition, computerized virtual surgery planning has been increasingly applied in various orthopedic procedures. Digital preoperative planning was developed mainly in the field of hip and knee joint replacement.…”

The Applications of Finite Element Analysis in Proximal Humeral Fractures

“…However, for investigation involved in finite element method, the boundary conditions become difficult to handle owing to the sophisticated structure of shoulder joint. It is impossible to simulate the real boundary conditions exactly with all the muscles and ligaments acting together [ 32 , 36 , 44 , 97 ]. Most of the studies we reviewed simplified the shoulder joints for investigation by ignoring the interaction of muscles, ligaments, bones, and other surrounding structures.…”

“…What is more, it has been used to compare different implants in fracture fixation [ 29 , 30 ], analyze biomechanics of bones [ 31 , 32 ], and even simulate various kinds of models in animal [ 33 , 34 ] and sports injuries [ 35 ]. FEA can not only help to make subject-specific pre-, intra-, or postoperative assessment, which is prerequisite for successful management, but also help reduce operation time, blood loss, rate of screw penetration, rate of screw loosening, intraoperative injuries, and fracture healing time, leading to successful fixation and anatomical restoration of fractures [ 36 , 37 ].…”

Suture anchor fixation may be an alternative to tension band wiring in olecranon fractures: Finite element analysis

“…FEA does not only evaluate pre-, intra-, and postoperative features of materials, but it also reduces operation time, blood loss, penetration rate of the screw, and fracture healing time, and helps in successful fixation and anatomic restoration of fractures. [7] In this study, we aimed to analyze and compare total deformations with TBW, IS and SA fixation methods, and to investigate practicality of SA fixation in olecranon fractures using FEA.…”