Universität zu Köln

Harbrecht, Andreas ORCID: 0000-0002-9951-7629, Hackl, Michael, Leschinger, Tim, Mueller, Lars P. and Wegmann, Kilian (2022). Focus on stability: biomechanical evaluation of external fixation technique versus locking plate osteosynthesis in 3-part proximal humeral fractures. J. Shoulder Elbow Surg., 31 (8). S. 1666 - 1674. NEW YORK: MOSBY-ELSEVIER. ISSN 1532-6500

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Abstract

Background: The purpose of this study was to investigate the primary stability and displacement tendencies of an external fixation system in 2 different configurations in comparison to locking plate fixation in a 3-part proximal humeral fracture model. Methods: Twenty-one fresh-frozen human cadaveric proximal humeral specimens were divided into 3 groups of 7 stripped specimens. An unstable 3-part fracture of the proximal humerus was set. Construct A consisted of the Galaxy Fixation Shoulder System, with fixation in accordance with the manufacturer's recommended technique (3 pairs of threaded wires). Construct B was fixed with an additional pair of threaded wires according to the recommendations of Gumina et al (4 pairs of threaded wires). The remaining 7 specimens were fixed with a locking plate. By use of an optical motion capture system, relative motion at the fracture site and failure load were evaluated during a cyclic loading protocol. Results: Plate osteosynthesis showed the highest cyclic load to failure (895 +/- 239 N; range, 597-1135 N), followed by construct B (692 +/- 121 N; range, 432-788 N) and construct A (350 +/- 190 N; range, 139-615 N). Statistically significant differences were found between plating and construct A (P < .001), between plating and construct B (P = .031), and between construct B and construct A (P = .013). Relative motion at the fracture site, in terms of change in distance during cyclic loading, was lowest with construct B measured at the peak load of 395 N after 11 steps (1.73 +/- 198 mm; range, 0.53-5.96 mm) and highest with construct A (8.46 +/- 10.67 mm; range, 2.26-20.79 mm). Angular change measured at the peak load after 11 steps was lowest with construct B (1.19 degrees +/- 0.36 degrees: range, 0.59 degrees-1.7 degrees) and highest with construct A (2.44 degrees +/- 1.63 degrees; range, 0.77 degrees-4.04 degrees). Statistically significant differences were found between construct A and construct B and between construct A and plating at various steps of cyclic loading. Conclusion: In this biomechanical study of unstable 3-part proximal humeral fractures, locking plate osteosynthesis demonstrated the highest possible load application. External fixator application with 8 threaded wires (construct B) revealed the least relative motion at the fracture site, without a statistically significant difference compared with locking plates. It therefore represents another valid technique for treatment regarding primary stability. The use of external fixator application with 6 threaded wires (construct A) resulted in the lowest stability and the highest rates of displacement. (C) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Harbrecht, Andreas UNSPECIFIED orcid.org/0000-0002-9951-7629 UNSPECIFIED Hackl, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Leschinger, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Lars P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wegmann, Kilian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-658000
DOI:	10.1016/j.jse.2022.01.144
Journal or Publication Title:	J. Shoulder Elbow Surg.
Volume:	31
Number:	8
Page Range:	S. 1666 - 1674
Date:	2022
Publisher:	MOSBY-ELSEVIER
Place of Publication:	NEW YORK
ISSN:	1532-6500
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SCREW AUGMENTATION; SHOULDER; COMPLICATIONS Multiple languages Orthopedics; Sport Sciences; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/65800