Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants

Füchtmeier, Bernd; May, Ryan; Hente, R.; Maghsudi, M.; Volk, M.; Hammer, J.; Nerlich, Michael; Prantl, Lukas

doi:10.1007/s00402-007-0319-6

Cited by 89 publications

(78 citation statements)

References 18 publications

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“…Only one study reported displacements [26], in the range 1.2-1.5 mm, under a 7.5 Nm cantilever bending moment. For the current study, at an equivalent bending moment of 7.5 Nm, displacement was 0.28 mm in the AP plane and 0.25 mm in the ML plane.…”

Section: Table 1 Literature Review Of Adult Human Humerus Materials Pmentioning

confidence: 99%

Mechanical characterization of fourth generation composite humerus

Grover

Albert

Wang

et al. 2011

Proc Inst Mech Eng H

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Abstract:Mechanical data on upper extremity surrogate bones, supporting use as biomechanical tools, is limited. The objective of this study was to characterize the structural behavior of the fourth generation composite humerus under simulated physiologic bending, specifically, stiffness, rigidity, and middiaphysial surface strains. Three humeri were tested in four-point bending, in anatomically defined anteroposterior(AP) and mediolateral(ML) planes. Stiffness and rigidity were derived using load-displacement data. Principal strains were determined at the anterior, posterior, medial and lateral surfaces in the humeral mid-diaphysial transverse plane of one specimen using stacked rosettes. Linear structural behavior was observed within test range. Average stiffness and rigidity were greater in the ML (918+18 N/mm; 98.4+1.9 Nm 2 ) than the AP plane (833+16 N/mm; 89.3+1.6 Nm 2 ), with little interspecimen variability. The ML/AP rigidity ratio was 1.1. Surface principal strains were similar at the anterior (5.41 /N) and posterior (5.43 /N) gauges for AP bending, and comparatively less for ML bending, i.e., 5.1 and 4.5 /N, at the medial and lateral gauges, respectively. The study provides novel strain and stiffness data for the fourth generation composite humerus, and adds to published construct rigidity data. Results support use of this composite bone as a tool for modeling and experimentation.

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Section: Table 1 Literature Review Of Adult Human Humerus Materials Pmentioning

confidence: 99%

Mechanical characterization of fourth generation composite humerus

Grover

Albert

Wang

et al. 2011

Proc Inst Mech Eng H

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“…12 Intramedullary devices are biomechanically superior to plates for treating proximal humeral fractures. 13 In a study of 25 patients with 2-and 3-part fractures treated with the Polarus nail, 20 achieved satisfactory-to-excellent functional outcomes in terms of the Constant score.…”

Section: Discussionmentioning

confidence: 99%

Polarus Nail Fixation for Proximal Humeral Fractures

Fazal

Baloch

Ashwood

2014

J Orthop Surg (Hong Kong)

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Purpose. To report the outcomes of Polarus nail fixation for displaced proximal humeral fractures. Methods. Medical records of 19 men and 27 women aged 26 to 84 (mean, 63) years who underwent fixation using a standard Polarus nail (n=34) or Polarus plus nail with shaft extension (n=12) for proximal humeral fractures of 2 and 3 parts (n=34) and 2-part with extension to the shaft (n=12) were reviewed. Fracture union, neck shaft angle, and hardware complications were evaluated using radiographs. Outcomes were assessed using the Constant score, the visual analogue scale for pain, and subjective satisfaction. The range of motion, grip strength, and ability to return to work were also recorded. Results. The mean follow-up was 20 (range, 15-28) months. The mean humeral neck shaft angle was 137.2º. 44 (96%) patients achieved fracture union after a mean of 14 (range, 11-16) 2014;22(2):195-8 radial nerve palsy (n=2), impingement symptoms caused by the prominent metal work (n=10), and missing of the proximal screws in the nail (n=4). Respectively in patients aged <60 (n=15) and ≥60 years (n=31), the mean Constant scores were 79 and 67 (p=0.04). The mean pain score improved from 93 to 15.5 at 12 months. 16 patients were very satisfied, 22 were satisfied, and 8 were not satisfied with the outcome. Of the latter, 3 were aged <60 years and 5 were aged ≥60 years. Conclusion. Polarus nail fixation for displaced proximal humeral fractures achieved good fracture union and satisfactory functional outcome, particularly in younger patients and those in active employment, but elderly dependent patients tended to have poor functional results. The rates of minor hardware problems and non-union in 3-part fractures were relatively high.

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“…The biomechanical studies have focused on locking plate osteosynthesis as well [35][36][37][38][39][40][41][42][43]. The stability of an osteosynthesis after proximal humeral fracture is very difficult to determine in vivo, because the fracture is subject to varying stress, and the quality of the bone shows a wide degree of variation [39].…”

Section: Introductionmentioning

confidence: 99%

“…The stability of an osteosynthesis after proximal humeral fracture is very difficult to determine in vivo, because the fracture is subject to varying stress, and the quality of the bone shows a wide degree of variation [39]. The number of scientific papers concerning biomechanical investigations of proximal humerus osteosynthesis is high [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. But these studies differ in implant selection, experimental set-up, fracture situations, loading applications and definitions of implant failure, which makes a comparison between them impossible.…”

Section: Introductionmentioning

confidence: 99%

Biology and Biomechanics in Osteosynthesis of Proximal Humerus Fractures

Hepp

Josten

2007

Eur J Trauma Emerg Surg

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Surgical treatment of proximal humeral fractures still remains a challenge. This is primarily due to the fact that sufficient implant fixation in humeral head fractures is often not achieved due to substantial bone tissue loss with increasing age. In the last few years the locking plates and locking nails have been introduced into clinical practice with varying results. The biomechanical studies have focused on locking plate osteosynthesis as well. The following paper focuses on bone quality, biomechanical studies and biology of proper osteosynthesis and reviews the most recent literature.

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Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants

Cited by 89 publications

References 18 publications

Mechanical characterization of fourth generation composite humerus

Mechanical characterization of fourth generation composite humerus

Polarus Nail Fixation for Proximal Humeral Fractures

Biology and Biomechanics in Osteosynthesis of Proximal Humerus Fractures

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