Universität zu Köln

Ott, Nadine, Harland, Arne ORCID: 0000-0001-7976-1360, Hackl, Michael ORCID: 0000-0002-6183-5621, Prescher, Andreas, Leschinger, Tim, Mu, Lars Peter and Wegmann, Kilian (2021). Primary stability of fixation methods for periprosthetic fractures of the humerus: a biomechanical investigation. J. Shoulder Elbow Surg., 30 (9). S. 2184 - 2191. NEW YORK: MOSBY-ELSEVIER. ISSN 1532-6500

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Abstract

Background: The incidence of periprosthetic fractures of the proximal humerus is gradually increasing, following an increase in reverse shoulder arthroplasties in recent years. Locking plate fixation and revision arthroplasty are both valuable treatment methods. However, the primary stability of fixation methods for periprosthetic fractures has not been investigated in detail. The aim of this study was to analyze and compare the primary stability of the common treatment measures. Materials and methods: Cemented reverse total shoulder arthroplasty (Delta Xtend; DePuy Synthes, Warsaw, IN, USA) was performed in 5 shoulders, and a distal, mid-diaphysis humeral fracture (Wright and Cofield type B) was induced. The implant was left in place, and 3 distinct fixation scenarios were tested: osteosynthesis using 4.5-mm locking plate fixation (subgroup A), 4.5-mm locking plate fixation with an additional 3.5-mm locking plate (subgroup B), and 4.5-mm locking plate fixation with an additional K-wire cerclage (subgroup C). The specimens were tested in a biomechanical setup simulating activities of daily living including rotation. Strain gauges (4-wire strain at 120 U; Vishay Measurements Group, Chartres, France) mounted on the 4.5-mm locking plates were used to evaluate the strain of the fixation and to give an estimate of primary stability. Results: Regarding the simulation of activities of daily living, no statistically significant differences were found in the measured strains on the locking plate between subgroups A, B, and C. A maximum measured strain of 216.85 mm/m in subgroup A resulted in bending of the locking plate (length, 134 mm) of 0.03 mm. In subgroup B (277.01 mm/m), the plate strained 0.04 mm compared with a strain measurement of 0.01 mm in subgroup C (75.93 mm/m). Conclusion: Additional K-wire cerclages or additional 3.5-mm locked plating did not increase primary stability. With a stable prosthetic implant in place, 4.5-mm locked plating is sufficient to address periprosthetic humeral shaft fractures in the present in vitro setup. Level of evidence: Basic Science Study; Biomechanics (c) 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ott, Nadine UNSPECIFIED UNSPECIFIED UNSPECIFIED Harland, Arne UNSPECIFIED orcid.org/0000-0001-7976-1360 UNSPECIFIED Hackl, Michael UNSPECIFIED orcid.org/0000-0002-6183-5621 UNSPECIFIED Prescher, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Leschinger, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Mu, Lars Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Wegmann, Kilian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-571839
DOI:	10.1016/j.jse.2020.12.027
Journal or Publication Title:	J. Shoulder Elbow Surg.
Volume:	30
Number:	9
Page Range:	S. 2184 - 2191
Date:	2021
Publisher:	MOSBY-ELSEVIER
Place of Publication:	NEW YORK
ISSN:	1532-6500
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TOTAL SHOULDER ARTHROPLASTY; BONE-MINERAL DENSITY; HOUNSFIELD UNITS; COMPLICATIONS; MANAGEMENT; REVISION; ADJACENT Multiple languages Orthopedics; Sport Sciences; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57183