Shoulder function after helical long PHILOS plate

Silva, Tomas Da; Rummel, Franziska; Knop, C.; Merkle, Tobias

doi:10.1007/s00590-021-02908-2

Cited by 6 publications

(1 citation statement)

References 16 publications

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“…A helical-shaped plate offers the potential to avoid distally the adjacent anatomical structures, such as the radial nerve. Several reports already demonstrated good clinical results using helical plates for treatment of humeral shaft fractures [8][9][10][11]. Furthermore, a recently published anatomical study demonstrated less axillary nerve stretching during insertion of a helically shaped PHILOS plate (DePuy Synthes, Zuchwil, Switzerland) with MIPO technique, as compared with straight PHILOS plates [12].…”

Section: Introductionmentioning

confidence: 99%

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Pastor,

Zderic,

Pastor

et al. 2023

Medicina

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Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint.

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Section: Introductionmentioning

confidence: 99%

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Pastor,

Zderic,

Pastor

et al. 2023

Medicina

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45° helical plates are a valid alternative to straight plates for treatment of proximal humeral shaft fractures

Pastor,

Zderic,

Beeres

et al. 2024

Journal Orthopaedic Research

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Helical plates used for proximal humeral shaft fracture fixation avoid the radial nerve distally as compared to straight plates. To investigate in a human cadaveric model the biomechanical competence of straight lateral plates versus 45° helical plates used for fixation of proximal comminuted humeral shaft fractures, eight pairs of human cadaveric humeri were instrumented using either a long straight PHILOS plate (Group 1) or a 45° helical plate (Group 2) for treatment of an unstable proximal humeral shaft fracture. All specimens were tested under non‐destructive quasi‐static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation was applied until failure and interfragmentary movements were monitored by motion tracking. Axial displacement (mm) was 3.13 ± 0.31 in Group 1 and 2.60 ± 0.42 in Group 2, p = 0.015. Flexion/extension deformation (°) in Group 1 and Group 2 was 0.56 ± 0.42 and 0.43 ± 0.23, p = 0.551. Varus/valgus deformation (°) was 6.39 ± 0.44 in Group 1 and 5.13 ± 0.87 in Group 2, p = 0.012. Shear (mm) and torsional (°) displacement were 5.36 ± 0.76 and 17.75 ± 1.06 in Group 1, and 5.03 ± 0.46 and 16.79 ± 1.36 in Group 2, p ≥ 0.090. Cycles to catastrophic failure were 10000 ± 1401 in Group 1 and 9082 ± 1933 in Group 2, p = 0.708. From a biomechanical perspective, 45° helical plating is associated with lower axial and varus/valgus displacement under axial loading and demonstrates comparable resistance to failure versus straight plating. Therefore, 45° helical plates can be considered as a valid alternative to straight plates for treatment of proximal humeral shaft fractures.

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Biomechanical analysis of helical versus straight plating of proximal third humeral shaft fractures

Pastor

Knegsel

Beeres

et al. 2023

Arch Orthop Trauma Surg

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Shoulder function after helical long PHILOS plate

Cited by 6 publications

References 16 publications

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

45° helical plates are a valid alternative to straight plates for treatment of proximal humeral shaft fractures

Biomechanical analysis of helical versus straight plating of proximal third humeral shaft fractures

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