Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study
The locking plate may provide improved fixation in osteoporotic bone; however, it has been reported to fail due to varus collapse or screw perforation of the articular surface, especially in osteoporotic bone with medial cortex comminution. Using bone graft as an intramedullary strut together with p...
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MDPI AG
2023-10-01
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| Online Access: | https://www.mdpi.com/2075-1729/13/11/2110 |
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| author | Chih-Kun Hsiao Yen-Wei Chiu Hao-Yuan Hsiao Yi-Jung Tsai Cheng-Hung Lee Cheng-Yo Yen Yuan-Kun Tu |
| author_facet | Chih-Kun Hsiao Yen-Wei Chiu Hao-Yuan Hsiao Yi-Jung Tsai Cheng-Hung Lee Cheng-Yo Yen Yuan-Kun Tu |
| author_sort | Chih-Kun Hsiao |
| collection | DOAJ |
| description | The locking plate may provide improved fixation in osteoporotic bone; however, it has been reported to fail due to varus collapse or screw perforation of the articular surface, especially in osteoporotic bone with medial cortex comminution. Using bone graft as an intramedullary strut together with plate fixation may result in a stronger construct. However, the drawbacks of bone grafts include limited supply, high cost, and infection risk. PMMA (so-called bone cement) has been widely used for implant fixation due to its good mechanical properties, fabricability, and biocompatibility. The risk of donor-site infection and the drawbacks of allografting may be overcome by considering PMMA struts as alternatives to fibular grafts for humeral intramedullary grafting surgeries. However, the potential effects of intramedullary PMMA strut on the dynamic behaviour of osteoporotic humerus fractures remain unclear. This study aimed to investigate the influence of an intramedullary PMMA strut on the stability of unstable proximal humeral fractures in an osteoporotic synthetic model. Two fixation techniques, a locking plate alone (non-strut group) and the same fixation augmented with an intramedullary PMMA strut (with-strut group), were cyclically tested in 20 artificial humeral models. Axially cyclic testing was performed to 450 N for 10,000 cycles, intercyclic motion, cumulated fragment migration, and residual deformation of the constructs were determined at periodic cyclic intervals, and the groups were compared. Results showed that adding an intramedullary PMMA strut could decrease 1.6 times intercyclic motion, 2 times cumulated fracture gap migration, and 1.8 times residual deformation from non-strut fixation. During cycling, neither screw pull-out, cut-through, nor implant failure was observed in the strut-augmented group. We concluded that the plate-strut mechanism could enhance the cyclic stability of the fixation and minimize the residual displacement of the fragment in treating osteoporotic proximal humeral unstable fractures. The PMMA strut has the potential to substitute donor bone and serve as an intramedullary support when used in combination with locking plate fixation. The intramedullary support with bone cement can be considered a solution in the treatment of osteoporotic proximal humeral fractures, especially when there is medial comminution. |
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| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T16:39:44Z |
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| spelling | doaj.art-026294cf234e4e678ed0c926771db1d42023-11-24T14:52:14ZengMDPI AGLife2075-17292023-10-011311211010.3390/life13112110Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical StudyChih-Kun Hsiao0Yen-Wei Chiu1Hao-Yuan Hsiao2Yi-Jung Tsai3Cheng-Hung Lee4Cheng-Yo Yen5Yuan-Kun Tu6Department of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung 824005, TaiwanDepartment of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung 824005, TaiwanDepartment of Orthopaedics, E-Da Hospital, I-Shou University, Kaohsiung 824005, TaiwanDepartment of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung 824005, TaiwanDepartment of Orthopedics, Taichung Veterans General Hospital, Taichung 407219, TaiwanDepartment of Orthopaedics, E-Da Hospital, I-Shou University, Kaohsiung 824005, TaiwanDepartment of Orthopaedics, E-Da Hospital, I-Shou University, Kaohsiung 824005, TaiwanThe locking plate may provide improved fixation in osteoporotic bone; however, it has been reported to fail due to varus collapse or screw perforation of the articular surface, especially in osteoporotic bone with medial cortex comminution. Using bone graft as an intramedullary strut together with plate fixation may result in a stronger construct. However, the drawbacks of bone grafts include limited supply, high cost, and infection risk. PMMA (so-called bone cement) has been widely used for implant fixation due to its good mechanical properties, fabricability, and biocompatibility. The risk of donor-site infection and the drawbacks of allografting may be overcome by considering PMMA struts as alternatives to fibular grafts for humeral intramedullary grafting surgeries. However, the potential effects of intramedullary PMMA strut on the dynamic behaviour of osteoporotic humerus fractures remain unclear. This study aimed to investigate the influence of an intramedullary PMMA strut on the stability of unstable proximal humeral fractures in an osteoporotic synthetic model. Two fixation techniques, a locking plate alone (non-strut group) and the same fixation augmented with an intramedullary PMMA strut (with-strut group), were cyclically tested in 20 artificial humeral models. Axially cyclic testing was performed to 450 N for 10,000 cycles, intercyclic motion, cumulated fragment migration, and residual deformation of the constructs were determined at periodic cyclic intervals, and the groups were compared. Results showed that adding an intramedullary PMMA strut could decrease 1.6 times intercyclic motion, 2 times cumulated fracture gap migration, and 1.8 times residual deformation from non-strut fixation. During cycling, neither screw pull-out, cut-through, nor implant failure was observed in the strut-augmented group. We concluded that the plate-strut mechanism could enhance the cyclic stability of the fixation and minimize the residual displacement of the fragment in treating osteoporotic proximal humeral unstable fractures. The PMMA strut has the potential to substitute donor bone and serve as an intramedullary support when used in combination with locking plate fixation. The intramedullary support with bone cement can be considered a solution in the treatment of osteoporotic proximal humeral fractures, especially when there is medial comminution.https://www.mdpi.com/2075-1729/13/11/2110PMMAintramedullary strutstabilityosteoporosis |
| spellingShingle | Chih-Kun Hsiao Yen-Wei Chiu Hao-Yuan Hsiao Yi-Jung Tsai Cheng-Hung Lee Cheng-Yo Yen Yuan-Kun Tu Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study Life PMMA intramedullary strut stability osteoporosis |
| title | Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study |
| title_full | Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study |
| title_fullStr | Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study |
| title_full_unstemmed | Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study |
| title_short | Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study |
| title_sort | cyclic stability of locking plate augmented with intramedullary polymethyl methacrylate pmma strut fixation for osteoporotic humeral fractures a biomechanical study |
| topic | PMMA intramedullary strut stability osteoporosis |
| url | https://www.mdpi.com/2075-1729/13/11/2110 |
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