Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?

Katthagen, J. Christoph; Schwarze, Michael; Bauer, L.; Meyer-Kobbe, J.; Voigt, C.; Hurschler, Christof; Lill, Helmut

doi:10.1016/j.otsr.2015.01.018

Cited by 14 publications

(8 citation statements)

References 26 publications

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“…In 2012, Rothstock et al [18] presented increased stability and decreased varus displacement using a supplementary Bscrewin-screw^configuration and advocated an additional ascending calcar screw for SAN. Contrarily, Katthagen et al [19] showed that an additional unlocked calcar screw did not increase stability in a two-part fracture model fixed using a SAN construct.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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Purpose Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this Bproximal anchoring point^(PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. Methods Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture. Results Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20°abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200-1.000 N) compared to those without the PAP (median, 325 N; range, 100-500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200-650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200-600 N; p = 0.240). Conclusions The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the Bproximal anchoring point's^rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.

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Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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“…Thus, in line with the results of Lill et al, the hybrid double plate osteosynthesis might give preferable results [ 30 ]. Especially for young patients with good bone substance and in cases of highly complex multi-fragment fractures, which were previously examined using hybrid double osteosynthesis, more rigid implants should be used [ 17 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…A cyclic compressive loading scenario with the humerus in a 20-degree abduction position was performed, similar to the investigations of Katthagen et al [ 18 ]. The force was applied in a sinusoidal form (1 Hz), ranging from a minimum of 10 N to a maximum of 250 N for 5000 cycles [ 14 , 17 , 18 , 22 ]. In the tests, the humerus were treated with normal saline every 10 minutes to hydrate them.…”

Section: Methodsmentioning

confidence: 99%

“…During the tests, the force and displacement were measured using a servo-hydraulic uniaxial testing machine (Dynamess, DYNA-MESS Prüfmaschinen GmbH, Aachen, Germany). Subsequently, a failure test with 0 degrees of abduction of the humerus and a testing speed of 0.1 mm per second was performed [ 17 , 18 , 22 , 23 ]. The following failure criteria were defined: a) gap closure, b) fracture of the humeral head, or c) shaft, or d) implant failure.…”

Section: Methodsmentioning

confidence: 99%

“…The clinical implications of this biomechanical study largely relate to optimizing the treatment of proximal humerus fractures. In the given study, human cadaveric specimens were treated with calcar screws (group 1) or double-plate osteosynthesis (group 2), using a proximal humerus injury model with a two-part fracture as described previously [ 17 – 21 ]. The following hypotheses were investigated:…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures

Theopold¹,

Schleifenbaum²,

Müller³

et al. 2018

PLoS ONE

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BackgroundTreating proximal humerus fractures can be challenging because of large metaphyseal defects that conceal anatomical landmarks. In such cases, medial cortical support with, for example, calcar screws, is mandatory. Nevertheless, varus dislocations and implant failures in patients with impaired bone quality persist. Thus, the need for effective treatment of these patients exists. Hybrid double plate osteosynthesis was introduced as an alternative, yielding similar results as calcar screws. However, a biomechanical comparison of the stability of these two techniques is pending.MethodsCadaveric humeral specimens were treated with plate osteosynthesis and calcar screws (group 1, n = 9) or hybrid double plate osteosynthesis (group 2, n = 9) using a proximal humerus fracture model with a two-part fracture. Displacement, stiffness, failure mode, and ultimate load were examined biomechanically in a cyclic compressive-loading scenario.ResultsAlthough the hybrid double plate osteosynthesis (group 2) tended to confer higher stiffnesses than the medial support screws at higher cycles (group 1), this trend was below the level of significance. The displacement revealed non-significantly lower values for group 1 as compared with group 2 for cycles 50 and 2000, but at 5000 cycles, group 2 offered non-significantly lower displacement values than group 1. The ultimate load tended to be non-significantly higher in the hybrid double plate osteosynthesis group (group 2: 1342±369 N, group 1: 855±408 N). Both groups yielded similar failure rates, with the majority of failures in group 2 being gap closures (n = 8), whereas those in group 1 being plate dislocations (n = 4).ConclusionsThe use of an additive plate osteosynthesis in the region of the bicipital groove may be a potential alternative to the previously-established method of using calcar screws. The biomechanical data obtained in this study suggests that hybrid double plate osteosynthesis is as rigid and robust as calcar screws.

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Biomechanical Testing of Additive Manufactured Proximal Humerus Fracture Fixation Plates

et al. 2019

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Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?

Abstract: The use of an additional unlocked calcar screw does not provide mechanical benefit in locked nailing of an unstable 2-part fracture of the surgical neck.

Cited by 14 publications

References 26 publications

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures

Biomechanical Testing of Additive Manufactured Proximal Humerus Fracture Fixation Plates

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