Finite element analysis of different fixation methods for
poor medial column support proximal humeral fracture

doi:10.3969/j.issn.2095-4344.2510

Abstract

Abstract:

BACKGROUND: The medial column fracture of the proximal humeral fracture is a type of fracture with high postoperative complications after internal fixation. Proximal humeral internal locking system is widely used in the proximal humeral fracture. The biomechanical stability of two different internal fixation models for the treatment of the poor medial column support proximal humeral fractures with proximal humeral internal locking system and proximal humeral internal locking system with fibular allograft augmentation is still unclear.

OBJECTIVE: To investigate the biomechanical stability of the proximal humeral internal locking system and proximal humeral internal locking system with fibular allograft augmentation in the poor medial column support proximal humeral fracture with finite element analysis, and to compare the difference in fixation modes in humeral calcar supporting screws under different fixing methods.

METHODS: The proximal CT data of osteoporosis were obtained. According to the 5-mm osteotomy of the humerus, the posterior medial column of the humerus was established and divided into two groups. Group A was the proximal humeral internal locking system plate group, in which the A1 group was placed in the proximal end of the plate, the A2 group was the E screw missing, the A3 group was the D screw missing; the B group received the proximal humeral internal locking system plate combined with fibular allograft augmentation, and all screws was placed in the proximal end of the plate in the B1 group. In the B2 group, E screw was missing; in the B3 group, D screw was missing. The three-dimensional finite element method was used to analyze the biomechanical stability of different groups of models under indirect violence.

RESULTS AND CONCLUSION: (1) In terms of structural stability, B group was significantly better than A group. The structural stability of A1 group and A3 group of A group was comparable and better than that in A2 group. In B group, the structural stability of B1 group and B2 group was comparable and superior to B3 group. (2) For the poor medial column support proximal humeral fracture, the mechanical stability of the proximal humeral internal locking system plate combined with fibular allograft augmentation was better than that of the proximal humeral internal locking system plate alone. When the fibular support was combined, the screw placement in the proximal end of the plate is optimal, and D screw has an important stabilizing effect on the support of the poor medial column support proximal humeral fracture.

Key words: proximal humeral fractures, poor medial column support, proximal humeral internal locking system, bone grafting, finite element analysis, biomechanics

CLC Number:

Liu Yan, Ge Hongqing, Guan Hua, Chen Wenzhi. Finite element analysis of different fixation methods for poor medial column support proximal humeral fracture [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1384-1389.

Figures/Tables 3

References

[1] SABESAN VJ, LOMBARDO D, PETERSEN-FITTS G, et al. National trends in proximal humerus fracture treatment patterns. Aging Clin Exp Res. 2017;29(6):1277-1283.
[2] MURRAY IR, AMIN AK, WHITE TO, et al. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br.2011;93(1):1-11.
[3] COURT-BROWN CM, GARG A, MCQUEEN MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-371.
[4] AARON D, SHATSKY J, PAREDES JC, et al. Proximal humeral fractures: internal fixation. J Bone Joint Surg Am. 2012;94(24):2280-2288.
[5] SUMREIN BO, HUTTUNEN TT, LAUNONEN AP, et al. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int. 2017;28(3):901-907.
[6] AKSU N, GOGUS A, KARA AN, et al. Complications encountered in proximal humerus fractures treated with locking plate fixation. Acta Orthop Traumatol Turc. 2010; 44(2):89-96.
[7] 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.
[8] 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-S207.
[9] 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.
[10] 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.
[11] 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.
[12] ALIUDDIN AM, IDREES Z, RAHIM NM, et al. Functional Outcome Of Proximal Humeral Fractures Treated With Philos Plate In Adults. J Ayub Med Coll Abbottabad.2016;28(2): 337-340.
[13] OPPEBOEN S, WIKEROY A, FUGLESANG H, et al. Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years. J Orthop Surg Res. 2018;13(1):197.
[14] 贾龙,王天兵,周靖,等. PHILOS接骨板治疗肱骨近端骨折时结构螺钉的使用分析[J].北京大学学报(医学版),2015,47(2): 269-271.
[15] SANDERS BS, BULLINGTON AB, MCGILLIVARY GR, et al. Biomechanical evaluation of locked plating in proximal humeral fractures. J Shoulder Elbow Surg. 2007;16(2): 229-234.
[16] 杨桂姣,高雨仁,王玉海,等.肱骨胫骨骨髓腔的应用解剖[J].解剖学杂志,1992,15(1):3-6.
[17] 张布和,王小平.腓骨的研究[J].解剖学研究,2001,23(4): 284-285.
[18] 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.
[19] LIANG D, YE LQ, JIANG XB, et al. Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures: a three-dimensional finite element analysis. J Surg Res. 2015;195(1):246-256.
[20] 马晓东,吴斗,任鹏宇,等.数字化技术在肱骨近端骨折的应用[J]. 中华临床医师杂志(电子版),2017,11(3):466-470.
[21] 王满宜.骨折治疗的AO原则[M].2版.上海:上海科学技术出版社, 2017.
[22] 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.
[23] 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.
[24] 何仿,李苏皖,林昊,等. 间接暴力所致肱骨骨折机制的三维有限元模拟[J].中国矫形外科杂志,2008,16(8):613-616.
[25] 孙涛,张英泽,马信龙,等. 2010年至2011年京津唐地区成人肱骨近端骨折的流行病学调查与分析[J].中华创伤骨科杂志,2015, 17(7):599-603.
[26] CHEN X, YU ZX, WANG HY, et al. Proximal humeral internal locking plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures: A randomized study. Medicine (Baltimore). 2019;98(17): e15271.
[27] ZHANG W, ZENG L, LIU Y, et al. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures. PLoS One. 2014;9(8):e103297.
[28] 李仁斌,陈建海.肱骨距的研究进展[J].中华肩肘外科电子杂志, 2014,2(2):118-120.
[29] ROBINSON CM, AMIN AK, GODLEY KC, et al. Modern perspectives of open reduction and plate fixation of proximal humerus fractures. J Orthop Trauma. 2011;25(10):618-629.
[30] PADEGIMAS EM, ZMISTOWSKI B, LAWRENCE C, et al. Defining optimal calcar screw positioning in proximal humerus fracture fixation. J Shoulder Elbow Surg. 2017;26(11): 1931-1937.
[31] HYMES RA, LEVINE MJ, SCHULMAN JE, et al. Mechanisms of failure of locked-plate fixation of the proximal humerus: acoustic emissions as a novel assessment modality. J Orthop Trauma. 2013;27(7):392-398.
[32] 任磊,孙永青,郝敬东,等.肱骨距支撑螺钉在肱骨近端Neer Ⅲ、Ⅳ型骨折中的应用分析[J].北京医学,2017,39(2):157-159.
[33] 周建华,王跃.有限元分析在骨科中的应用及研究进展[J]. 实用医院临床杂志,2018,15(1):205-208.