Finite element analysis of different fibular support methods to reconstruct the poor medial column of humeral proximal fractures

doi:10.12307/2023.298

Abstract

Abstract: BACKGROUND: The method of fibular allograft to reconstruct the poor medial column of humeral proximal fractures has gradually been widely used in clinic, while the best support site in the intramedullary cavity is still controversial, and it is necessary to study its stability through biomechanical approach.
OBJECTIVE: To explore the biomechanical stability of the fibula in the center of the medullary cavity, anterolateral, anteromedial, posterolateral, and posteromedial positions using a finite element analysis method.
METHODS: The proximal humeral CT data of an osteoporosis female patient were obtained, modeled by Mimics 19.0 software and Geomagic Wrap software, and osteotomized in Soildworks 2017 software according to 5 mm below the anatomical neck of the humerus to establish a poor medial column support proximal humeral fracture model. The position of the fibula in the medullary cavity was divided into five groups. The fibula was located in center of the medullary cavity named F-C group; the fibula in anteromedial side of the medullary cavity named F-AL group; the fibula in anteromedial side of the medullary cavity named F-AM group; the fibula in posterolateral side of the medullary cavity named F-PL group; the fibula in posteromedial side of the medullary cavity named F-PM group. The data were imported into Ansys 2019 software to simulate the biomechanical stability of different grouping models under indirect violence.
RESULTS AND CONCLUSION: (1) Under axial load of 600 N, humeral stress: F-PL group (49.706 MPa) < F-C group (57.980 MPa) < F-AL group (58.519 MPa) < F-PM group (61.868 MPa) < F -AM group (63.886 MPa); internal fixation stress: F-AM group (106.310 MPa) < F-PM group (110.030 MPa) < F-C group (111.940 MPa) < F-PL group (114.320 MPa) < F-AL group (122.98 MPa). (2) Under 600 N axial loads, humeral deformation: F-PM group (0.352 mm) < F-PL group (0.416 mm) < F-C group (0.431 mm) < F-AM group (0.549 mm) < F-AL group (0.574 mm); internal fixation deformation: F-PM group (0.127 mm) < F-PL group (0.187 mm) < F-C group (0.191 mm) < F-AM group (0.272 mm) < F-AL group (0.290 mm). (3) Relative displacement of the fracture: F-PM group (0.048 mm) was approximately 0.54 times as large as the F-PL group (0.088 mm) and F-AM group (0.088 mm), and the F-C and F-AL groups were 0.067 mm and 0.103 mm. (4) The results of the study showed that the F-PM group had the least displacement and more distributed stresses, indicating that the biomechanical stability of placing the fibula on posteromedial side of the medullary cavity was better than that of placing the fibula in the center of the medullary cavity, and the biomechanical stability of placing the fibula on the lateral side of the medullary cavity was the worst.

Key words: proximal humerus fractures, proximal humeral internal locking system, bone grafting, finite element analysis, biomechanics

CLC Number:

Liu Yan, Ge Hongqing, Chen Wenzhi, Liang Zeqian, Li Junye, He Jielong. Finite element analysis of different fibular support methods to reconstruct the poor medial column of humeral proximal fractures[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(18): 2804-2808.

Figures/Tables 5

References

[1] IGLESIAS-RODRÍGUEZ S, DOMÍNGUEZ-PRADO DM, GARCÍA-REZA A, et al. Epidemiology of proximal humerus fractures. J Orthop Surg Res. 2021;16(1):402.
[2] PASSARETTI D, CANDELA V, SESSA P, et al. Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg. 2017;26(12):2117-2124.
[3] SUMREIN BO, HUTTUNEN TT, LAUNONEN AP, et al. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int. 2017;28(3):901-907.
[4] VIJAYVARGIYA M, PATHAK A, GAUR S. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res. 2016;10(8):RC01-05.
[5] GREGORY TM, VANDENBUSSCHE E, AUGEREAU B. Surgical treatment of three and four-part proximal humeral fractures. Orthop Traumatol Surg Res. 2013;99(1 Suppl):S197-207.
[6] KONRAD G, BAYER J, HEPP P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 1:85-95.
[7] PAVONE V, VESCIO A, DENARO R, et al. Use of different devices for surgical treatment of proximal humerus fractures in adults: a systematic review. Acta Biomed. 2021;92(4):e2021198.
[8] GARDNER MJ, BORAIAH S, HELFET DL, et al. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma. 2008;22(3):195-200.
[9] CHOW RM, BEGUM F, BEAUPRE LA, et al. Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft. J Shoulder Elbow Surg. 2012;21(7):894-901.
[10] CHEN H, JI X, ZHANG Q, et al. Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures. J Orthop Surg Res. 2015;10:114.
[11] 唐迪.锁定钢板结合异体腓骨支撑与单独锁定钢板固定治疗肱骨近端骨折疗效的Meta分析[D].重庆:重庆医科大学,2021.
[12] 沈施耘,李雄峰,吴猛,等.锁定钢板结合不同腓骨植骨方式治疗肱骨近端骨折的生物力学稳定性分析[J].中华创伤骨科杂志,2019,21(5):427-431.
[13] CLAVERT P, ZERAH M, KRIER J, et al. Finite element analysis of the strain distribution in the humeral head tubercles during abduction: comparison of young and osteoporotic bone. Surg Radiol Anat. 2006;28(6):581-587.
[14] KENNEDY J, MOLONY D, BURKE NG, et al. Effect of calcium triphosphate cement on proximal humeral fracture osteosynthesis: a cadaveric biomechanical study. J Orthop Surg (Hong Kong). 2013;21(2):173-177.
[15] KANNUS P, PALVANEN M, NIEMI S, et al. Rate of proximal humeral fractures in older Finnish women between 1970 and 2007. Bone. 2009;44(4):656-659.
[16] CRUICKSHANK D, LEFAIVRE KA, JOHAL H, et al. A scoping review of biomechanical testing for proximal humerus fracture implants. BMC Musculoskelet Disord. 2015;16:175.
[17] 章伟.新型肱骨近端锁定钢板的三维有限元模型建立及生物力学研究[D].苏州:苏州大学,2014.
[18] 何仿.人体肩关节三维有限元模型的建立、验证及在肱骨骨折机制研究方面的应用[D].上海:第二军医大学,2006.
[19] MIN KS, SHERIDAN B, WARYASZ GR, et al. Predicting reoperation after operative treatment of proximal humerus fractures. Eur J Orthop Surg Traumatol. 2021; 31(6):1105-1112.
[20] HE Y, HE J, WANG F, et al. Application of Additional Medial Plate in Treatment of Proximal Humeral Fractures With Unstable Medial Column: A Finite Element Study and Clinical Practice. Medicine (Baltimore). 2015;94(41):e1775.
[21] ZHU L, LIU Y, YANG Z, et al. Locking plate fixation combined with iliac crest bone autologous graft for proximal humerus comminuted fracture. Chin Med J (Engl). 2014;127(9):1672-1676.
[22] CHEN H, JI X, ZHANG Q, et al. Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures. J Orthop Surg Res. 2015;10:114.
[23] JANG Y, KIM D. Biomechanical study of Proximal humeral fracture fixation: Locking plate with medial support screw vs. locking plate with intramedullary fibular graft. Clin Biomech (Bristol, Avon). 2021;90:105510.
[24] PANCHAL K, JEONG JJ, PARK SE, et al. Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft. Int Orthop. 2016;40(3):569-577.
[25] CUI X, CHEN H, MA B, et al. Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study. BMC Musculoskelet Disord. 2019;20(1):511.