Reconstruction of proximal humeral fractures with a reduced number of screws and a reinforced bone substitute.
Augmentation
Locking plate
Number of screws
Osteoporotic multi-fragment fracture
Proximal humeral fracture
Journal
Medical engineering & physics
ISSN: 1873-4030
Titre abrégé: Med Eng Phys
Pays: England
ID NLM: 9422753
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
09
01
2020
revised:
02
06
2020
accepted:
08
06
2020
entrez:
26
7
2020
pubmed:
28
7
2020
medline:
19
8
2021
Statut:
ppublish
Résumé
Multi-fragmented fractures of the proximal humerus are difficult to treat, especially in the case of osteoporotic bone. Intra-operative risks include cartilage damage when inserting multiple screws. A common post-operative complication is distal-varus collapse of the head. The aim of this study was to investigate if an Innovative technique (reduced number of screws and injection of a beta-TCP additivated partially resorbable cement) provides the same or better stability of the reconstructed head compared to the Standard technique (using more screws). A four-fragment fracture was simulated in six pairs of humeri, with partial removal of the cancellous bone to simulate osteoporotic "eggshell" defect. One humerus of each pair was repaired with a Standard (locking plate, 2 cortical and 6 locking screws), and the other with the Innovative technique (same plate, 2 cortical and only 3 locking screws, plus cement injection). The reconstructed specimens were subjected to a biomechanical test where a cyclic force of increasing amplitude was applied axially until failure. The Innovative reconstructions withstood a force 3.49 times larger than the contralateral Standard reconstructions before failure started. The maximum force before final collapse for the Innovative reconstructions was 4.24 times larger than the contralateral Standard reconstructions. These differences were statistically significant. The Innovative reconstructions, based on fewer screws and beta-TCP additivated acrylic cement, showed positive results, demonstrating better biomechanical properties compared to the Standard reconstructions. These laboratory findings, along with the advantages of a reduced number of screws, may help perform a surgically safer, and more effective procedure in osteoporotic patients.
Identifiants
pubmed: 32709270
pii: S1350-4533(20)30093-X
doi: 10.1016/j.medengphy.2020.06.002
pii:
doi:
Substances chimiques
Bone Substitutes
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
97-103Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None