Biomechanical Comparison of a Proximal Humeral Locking Plate Using Two Methods of Head Fixation

Ross A Schumer; Kara Muckley; Ronald J Markert; Michael J. Prayson; Jonathan Heflin; Tarun Goswami

doi:10.1016/j.jse.2009.11.003

Biomechanical Comparison of a Proximal Humeral Locking Plate Using Two Methods of Head Fixation

Ross A Schumer, Kara Muckley, Ronald J Markert, Michael J. Prayson, Jonathan Heflin, Tarun Goswami

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3> Hypothesis </h3> <p id="x-x-simple-para0040"> Locking plates have emerged as the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/implant" title="Learn more about Implant from ScienceDirect's AI-generated Topic Pages"> implant </a> of choice for stabilization of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/proximal-humerus-fracture" title="Learn more about Proximal Humerus Fracture from ScienceDirect's AI-generated Topic Pages"> proximal humeral fractures </a> . The biomechanical properties of a locked plating system using smooth <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/pneumoencephalography" title="Learn more about Pneumoencephalography from ScienceDirect's AI-generated Topic Pages"> pegs </a> vs threaded screws for fixation of the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/humeral-head" title="Learn more about Humeral Head from ScienceDirect's AI-generated Topic Pages"> humeral head </a> were compared to test the hypothesis that there would be no biomechanical difference between pegs and threaded screws. <h3> Materials and methods </h3> <p id="x-x-simple-para0045"> Sixteen pairs of fresh frozen cadaveric <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/humerus" title="Learn more about Humerus from ScienceDirect's AI-generated Topic Pages"> humeri </a> were randomized to have a surgical <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/neck" title="Learn more about Neck from ScienceDirect's AI-generated Topic Pages"> neck </a> gap <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/osteotomy" title="Learn more about Osteotomy from ScienceDirect's AI-generated Topic Pages"> osteotomy </a> stabilized with a locked plate using threaded screws (n = 8) or smooth pegs (n = 8). The intact contralateral humerus served as a control. Each <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/specimen" title="Learn more about Specimen from ScienceDirect's AI-generated Topic Pages"> specimen </a> was tested with simultaneous cyclic axial compression (40 Nm) and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/torsion" title="Learn more about Torsion from ScienceDirect's AI-generated Topic Pages"> torsion </a> (both ±2 Nm and ±5 Nm) for 6000 cycles. All specimens were loaded to failure. Interfragmentary motion and load-displacement curves were analyzed to identify differences between the groups. Our data were then compared to previously published forces across the glenohumeral <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/joint" title="Learn more about Joint from ScienceDirect's AI-generated Topic Pages"> joint </a> to provide evidence based recommendations for postoperative use of the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/shoulder" title="Learn more about Shoulder from ScienceDirect's AI-generated Topic Pages"> shoulder </a> . <h3> Results </h3> <p id="x-x-simple-para0050"> There was a statistically significant difference between test specimens and their paired control ( <em> P </em> < .001) in cyclic testing and load to failure. Differences between the smooth pegs and threaded screws were not statistically significant. <h3> Discussion </h3> <p id="x-x-simple-para0055"> There is no biomechanical difference between locked smooth pegs and locked threaded screws for proximal fragment fixation in an unstable 2-part proximal humeral fracture model. <h3> Conclusion </h3> <p id="x-x-simple-para0060"> Our study contributes to the published evidence evaluating forces across the glenohumeral joint and suggests that early use of the affected extremity for simple activities of daily living may be safe. Use of the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/arm" title="Learn more about Arm from ScienceDirect's AI-generated Topic Pages"> arm </a> for assisted <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/mobilization" title="Learn more about Mobilization from ScienceDirect's AI-generated Topic Pages"> ambulation </a> requiring a crutch, cane, walker, or wheelchair should be determined on a case-by-case <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/base" title="Learn more about Base from ScienceDirect's AI-generated Topic Pages"> basis </a> . </p> </p> </p> </p> </p></p>

Original language	American English
Journal	Journal of Shoulder and Elbow Surgery
Volume	19
DOIs	https://doi.org/10.1016/j.jse.2009.11.003
State	Published - Jun 1 2010

Disciplines

Internal Medicine
Medical Specialties
Medicine and Health Sciences

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@article{9a5ca0bb0b844b1ab014ba454f5d5d91,

title = "Biomechanical Comparison of a Proximal Humeral Locking Plate Using Two Methods of Head Fixation",

abstract = " Hypothesis Locking plates have emerged as the implant of choice for stabilization of proximal humeral fractures . The biomechanical properties of a locked plating system using smooth pegs vs threaded screws for fixation of the humeral head were compared to test the hypothesis that there would be no biomechanical difference between pegs and threaded screws. Materials and methods Sixteen pairs of fresh frozen cadaveric humeri were randomized to have a surgical neck gap osteotomy stabilized with a locked plate using threaded screws (n = 8) or smooth pegs (n = 8). The intact contralateral humerus served as a control. Each specimen was tested with simultaneous cyclic axial compression (40 Nm) and torsion (both ±2 Nm and ±5 Nm) for 6000 cycles. All specimens were loaded to failure. Interfragmentary motion and load-displacement curves were analyzed to identify differences between the groups. Our data were then compared to previously published forces across the glenohumeral joint to provide evidence based recommendations for postoperative use of the shoulder . Results There was a statistically significant difference between test specimens and their paired control ( P < .001) in cyclic testing and load to failure. Differences between the smooth pegs and threaded screws were not statistically significant. Discussion There is no biomechanical difference between locked smooth pegs and locked threaded screws for proximal fragment fixation in an unstable 2-part proximal humeral fracture model. Conclusion Our study contributes to the published evidence evaluating forces across the glenohumeral joint and suggests that early use of the affected extremity for simple activities of daily living may be safe. Use of the arm for assisted ambulation requiring a crutch, cane, walker, or wheelchair should be determined on a case-by-case basis . ",

author = "Schumer, {Ross A} and Kara Muckley and Markert, {Ronald J} and Prayson, {Michael J.} and Jonathan Heflin and Tarun Goswami",

year = "2010",

month = jun,

day = "1",

doi = "10.1016/j.jse.2009.11.003",

language = "American English",

volume = "19",

journal = "Journal of Shoulder and Elbow Surgery",

}

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T1 - Biomechanical Comparison of a Proximal Humeral Locking Plate Using Two Methods of Head Fixation

AU - Schumer, Ross A

AU - Muckley, Kara

AU - Markert, Ronald J

AU - Prayson, Michael J.

AU - Heflin, Jonathan

AU - Goswami, Tarun

PY - 2010/6/1

Y1 - 2010/6/1

N2 - Hypothesis Locking plates have emerged as the implant of choice for stabilization of proximal humeral fractures . The biomechanical properties of a locked plating system using smooth pegs vs threaded screws for fixation of the humeral head were compared to test the hypothesis that there would be no biomechanical difference between pegs and threaded screws. Materials and methods Sixteen pairs of fresh frozen cadaveric humeri were randomized to have a surgical neck gap osteotomy stabilized with a locked plate using threaded screws (n = 8) or smooth pegs (n = 8). The intact contralateral humerus served as a control. Each specimen was tested with simultaneous cyclic axial compression (40 Nm) and torsion (both ±2 Nm and ±5 Nm) for 6000 cycles. All specimens were loaded to failure. Interfragmentary motion and load-displacement curves were analyzed to identify differences between the groups. Our data were then compared to previously published forces across the glenohumeral joint to provide evidence based recommendations for postoperative use of the shoulder . Results There was a statistically significant difference between test specimens and their paired control ( P < .001) in cyclic testing and load to failure. Differences between the smooth pegs and threaded screws were not statistically significant. Discussion There is no biomechanical difference between locked smooth pegs and locked threaded screws for proximal fragment fixation in an unstable 2-part proximal humeral fracture model. Conclusion Our study contributes to the published evidence evaluating forces across the glenohumeral joint and suggests that early use of the affected extremity for simple activities of daily living may be safe. Use of the arm for assisted ambulation requiring a crutch, cane, walker, or wheelchair should be determined on a case-by-case basis .

AB - Hypothesis Locking plates have emerged as the implant of choice for stabilization of proximal humeral fractures . The biomechanical properties of a locked plating system using smooth pegs vs threaded screws for fixation of the humeral head were compared to test the hypothesis that there would be no biomechanical difference between pegs and threaded screws. Materials and methods Sixteen pairs of fresh frozen cadaveric humeri were randomized to have a surgical neck gap osteotomy stabilized with a locked plate using threaded screws (n = 8) or smooth pegs (n = 8). The intact contralateral humerus served as a control. Each specimen was tested with simultaneous cyclic axial compression (40 Nm) and torsion (both ±2 Nm and ±5 Nm) for 6000 cycles. All specimens were loaded to failure. Interfragmentary motion and load-displacement curves were analyzed to identify differences between the groups. Our data were then compared to previously published forces across the glenohumeral joint to provide evidence based recommendations for postoperative use of the shoulder . Results There was a statistically significant difference between test specimens and their paired control ( P < .001) in cyclic testing and load to failure. Differences between the smooth pegs and threaded screws were not statistically significant. Discussion There is no biomechanical difference between locked smooth pegs and locked threaded screws for proximal fragment fixation in an unstable 2-part proximal humeral fracture model. Conclusion Our study contributes to the published evidence evaluating forces across the glenohumeral joint and suggests that early use of the affected extremity for simple activities of daily living may be safe. Use of the arm for assisted ambulation requiring a crutch, cane, walker, or wheelchair should be determined on a case-by-case basis .

UR - https://corescholar.libraries.wright.edu/internal_medicine/111

U2 - 10.1016/j.jse.2009.11.003

DO - 10.1016/j.jse.2009.11.003

M3 - Article

C2 - 20189837

VL - 19

JO - Journal of Shoulder and Elbow Surgery

JF - Journal of Shoulder and Elbow Surgery

ER -

Biomechanical Comparison of a Proximal Humeral Locking Plate Using Two Methods of Head Fixation

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