Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study
<i>Background and Objectives</i>: 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 pl...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/11/2043 |
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| author | Torsten Pastor Ivan Zderic Tatjana Pastor Ludmil Drenchev Hristo Kostov Skulev Kenneth P. van Knegsel Mark Lenz Björn-Christian Link Boyko Gueorguiev Frank J. P. Beeres |
| author_facet | Torsten Pastor Ivan Zderic Tatjana Pastor Ludmil Drenchev Hristo Kostov Skulev Kenneth P. van Knegsel Mark Lenz Björn-Christian Link Boyko Gueorguiev Frank J. P. Beeres |
| author_sort | Torsten Pastor |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: 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. <i>Materials and Methods</i>: 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. <i>Results</i>: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (<i>p</i> ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (<i>p</i> ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (<i>p</i> < 0.001) and in Group 4 versus Group 1 (<i>p</i> = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (<i>p</i> ≤ 0.024) and in Group 1 versus Group 2 (<i>p</i> < 0.001). <i>Conclusions</i>: 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. |
| first_indexed | 2024-03-09T16:37:35Z |
| format | Article |
| id | doaj.art-d4e1baaa706e424e9dc2e39438f4ea02 |
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| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T16:37:35Z |
| publishDate | 2023-11-01 |
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| series | Medicina |
| spelling | doaj.art-d4e1baaa706e424e9dc2e39438f4ea022023-11-24T14:55:09ZengMDPI AGMedicina1010-660X1648-91442023-11-015911204310.3390/medicina59112043Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical StudyTorsten Pastor0Ivan Zderic1Tatjana Pastor2Ludmil Drenchev3Hristo Kostov Skulev4Kenneth P. van Knegsel5Mark Lenz6Björn-Christian Link7Boyko Gueorguiev8Frank J. P. Beeres9AO Research Institute Davos, 7270 Davos, SwitzerlandAO Research Institute Davos, 7270 Davos, SwitzerlandAO Research Institute Davos, 7270 Davos, SwitzerlandInstitute of Metal Science, Equipment and Technologies for Hydro- and Aerodynamics Center “Acad. A. Balevski”, Bulgarian Academy of Sciences, 1000 Sofia, BulgariaInstitute of Metal Science, Equipment and Technologies for Hydro- and Aerodynamics Center “Acad. A. Balevski”, Bulgarian Academy of Sciences, 1000 Sofia, BulgariaAO Research Institute Davos, 7270 Davos, SwitzerlandDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, 07747 Jena, GermanyDepartment of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, SwitzerlandAO Research Institute Davos, 7270 Davos, SwitzerlandDepartment of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland<i>Background and Objectives</i>: 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. <i>Materials and Methods</i>: 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. <i>Results</i>: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (<i>p</i> ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (<i>p</i> ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (<i>p</i> < 0.001) and in Group 4 versus Group 1 (<i>p</i> = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (<i>p</i> ≤ 0.024) and in Group 1 versus Group 2 (<i>p</i> < 0.001). <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/59/11/2043unstable humeral fracturehelical platinghumerusMIPObiomechanics |
| spellingShingle | Torsten Pastor Ivan Zderic Tatjana Pastor Ludmil Drenchev Hristo Kostov Skulev Kenneth P. van Knegsel Mark Lenz Björn-Christian Link Boyko Gueorguiev Frank J. P. Beeres Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study Medicina unstable humeral fracture helical plating humerus MIPO biomechanics |
| title | Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study |
| title_full | Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study |
| title_fullStr | Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study |
| title_full_unstemmed | Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study |
| title_short | Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study |
| title_sort | helical plating compared with straight plating and nailing for treatment of proximal third humeral shaft fractures a biomechanical study |
| topic | unstable humeral fracture helical plating humerus MIPO biomechanics |
| url | https://www.mdpi.com/1648-9144/59/11/2043 |
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