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Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study

Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects—weakening the osteosynthesis construct—are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomecha...

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Autores principales: Zhelev, Daniel, Hristov, Stoyan, Zderic, Ivan, Ivanov, Stoyan, Visscher, Luke, Baltov, Asen, Ribagin, Simeon, Stoffel, Karl, Kralinger, Franz, Winkler, Jörg, Richards, R. Geoff, Varga, Peter, Gueorguiev, Boyko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10536689/
https://www.ncbi.nlm.nih.gov/pubmed/37763723
http://dx.doi.org/10.3390/medicina59091604
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author Zhelev, Daniel
Hristov, Stoyan
Zderic, Ivan
Ivanov, Stoyan
Visscher, Luke
Baltov, Asen
Ribagin, Simeon
Stoffel, Karl
Kralinger, Franz
Winkler, Jörg
Richards, R. Geoff
Varga, Peter
Gueorguiev, Boyko
author_facet Zhelev, Daniel
Hristov, Stoyan
Zderic, Ivan
Ivanov, Stoyan
Visscher, Luke
Baltov, Asen
Ribagin, Simeon
Stoffel, Karl
Kralinger, Franz
Winkler, Jörg
Richards, R. Geoff
Varga, Peter
Gueorguiev, Boyko
author_sort Zhelev, Daniel
collection PubMed
description Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects—weakening the osteosynthesis construct—are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomechanical study aimed to analyze the stability of plated unstable PHFs augmented via implementation of this technique versus no augmentation. Materials and Methods: Three-part AO/OTA 11-B1.1 unstable PHFs with metaphyseal defects were created in sixteen paired human cadaveric humeri (average donor age 76 years, range 66–92 years), pairwise assigned to two groups for locked plate fixation with identical implant configuration. In one of the groups, six-milliliter polymethylmethacrylate bone cement with medium viscosity (seven minutes after mixing) was placed manually through the lateral window in the defect of the humerus head after its anatomical reduction to the shaft and prior to the anatomical reduction of the greater tuberosity fragment. All specimens were tested biomechanically in a 25° adduction, applying progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary movements were monitored by motion tracking and X-ray imaging. Results: Initial stiffness was not significantly different between the groups, p = 0.467. Varus deformation of the humerus head fragment, fracture displacement at the medial humerus head aspect, and proximal screw migration and cut-out were significantly smaller in the augmented group after 2000, 4000, 6000, 8000 and 10,000 cycles, p ≤ 0.019. Cycles to 5° varus deformation of the humerus head fragment—set as a clinically relevant failure criterion—and failure load were significantly higher in the augmented group, p = 0.018. Conclusions: From a biomechanical standpoint, augmentation with polymethylmethacrylate bone cement placed in the metaphyseal humerus head defect of plated unstable PHFs considerably enhances fixation stability and can reduce the risk of postoperative complications.
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spelling pubmed-105366892023-09-29 Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study Zhelev, Daniel Hristov, Stoyan Zderic, Ivan Ivanov, Stoyan Visscher, Luke Baltov, Asen Ribagin, Simeon Stoffel, Karl Kralinger, Franz Winkler, Jörg Richards, R. Geoff Varga, Peter Gueorguiev, Boyko Medicina (Kaunas) Article Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects—weakening the osteosynthesis construct—are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomechanical study aimed to analyze the stability of plated unstable PHFs augmented via implementation of this technique versus no augmentation. Materials and Methods: Three-part AO/OTA 11-B1.1 unstable PHFs with metaphyseal defects were created in sixteen paired human cadaveric humeri (average donor age 76 years, range 66–92 years), pairwise assigned to two groups for locked plate fixation with identical implant configuration. In one of the groups, six-milliliter polymethylmethacrylate bone cement with medium viscosity (seven minutes after mixing) was placed manually through the lateral window in the defect of the humerus head after its anatomical reduction to the shaft and prior to the anatomical reduction of the greater tuberosity fragment. All specimens were tested biomechanically in a 25° adduction, applying progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary movements were monitored by motion tracking and X-ray imaging. Results: Initial stiffness was not significantly different between the groups, p = 0.467. Varus deformation of the humerus head fragment, fracture displacement at the medial humerus head aspect, and proximal screw migration and cut-out were significantly smaller in the augmented group after 2000, 4000, 6000, 8000 and 10,000 cycles, p ≤ 0.019. Cycles to 5° varus deformation of the humerus head fragment—set as a clinically relevant failure criterion—and failure load were significantly higher in the augmented group, p = 0.018. Conclusions: From a biomechanical standpoint, augmentation with polymethylmethacrylate bone cement placed in the metaphyseal humerus head defect of plated unstable PHFs considerably enhances fixation stability and can reduce the risk of postoperative complications. MDPI 2023-09-05 /pmc/articles/PMC10536689/ /pubmed/37763723 http://dx.doi.org/10.3390/medicina59091604 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zhelev, Daniel
Hristov, Stoyan
Zderic, Ivan
Ivanov, Stoyan
Visscher, Luke
Baltov, Asen
Ribagin, Simeon
Stoffel, Karl
Kralinger, Franz
Winkler, Jörg
Richards, R. Geoff
Varga, Peter
Gueorguiev, Boyko
Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study
title Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study
title_full Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study
title_fullStr Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study
title_full_unstemmed Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study
title_short Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique—A Biomechanical Cadaveric Study
title_sort treatment of metaphyseal defects in plated proximal humerus fractures with a new augmentation technique—a biomechanical cadaveric study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10536689/
https://www.ncbi.nlm.nih.gov/pubmed/37763723
http://dx.doi.org/10.3390/medicina59091604
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