Artikel
Plated proximal humerus fractures: A novel technique for treatment of metaphyseal voids
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Autoren
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Boyko Gueorguiev
- AO Research Institute Davos, Davos, Switzerland
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Daniel Zhelev
- AO Research Institute Davos, Davos, Switzerland
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Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
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Asen Baltov
- University Hospital for Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
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Simeon Ribagin
- University Prof. Dr. Asen Zlatarov Burgas, Burgas, Bulgaria
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Geoff Richards
- AO Research Institute Davos, Davos, Switzerland
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Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Stoyan Hristov
- University Multiprofile Hospital for Active Treatment Burgas, University Prof. Dr. Asen Zlatarov Burgas, Burgas, Bulgaria
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
Text
Objectives: The treatment of unstable proximal humerus fractures with metaphyseal defects − weakening the osteosynthesis construct − is challenging. A novel technique for cement augmentation of plated complex proximal humerus fractures with metaphyseal voids was recently developed. The aim of this biomechanical study was to assess the stability of plated complex humerus fractures augmented according to the novel technique versus no augmentation.
Methods: Three-part unstable proximal humerus fractures with posttraumatic voids type AO/OTA 11-B1 were reproduced in 16 paired human cadaveric humeri with 76 years average age of donors (range 66−92), assigned pairwise to 2 groups for locked plating with identical screw configuration. In one of the groups, 6 mL PMMA-based partially-cured bone cement of medium viscosity (7 min after mixing) was manually placed through the traumatic lateral window into the void of the humeral head prior to screw insertion. Biomechanical testing was performed in 20° adduction of the specimens under applied progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary and bone-implant movements were captured by means of motion tracking and triggered x-ray imaging.
Figure 1 [Fig. 1]
Results and conclusion: Initial stiffness was not significantly different between the groups, p = 0.47. Varus deformation, fracture displacement at the medial aspect of the humeral head, cut-out and migration of the proximal plate screws were all significantly smaller in the augmented group after 2,000, 4,000, 6,000, 8,000 and 10,000 cycles, p < 0.01. Number of cycles to 2 mm fracture displacement at the medial aspect of the humeral head was significantly higher in the augmentated group, p = 0.02.
From a biomechanical perspective, augmentation with PMMA-based bone cement placed in the posttraumatic void of the humeral head during locked plating of unstable proximal humerus fractures considerably increases fixation stability and can reduce the risk of postoperative biomechanically-related complications.
