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Euler, SA; Petri, M; Venderley, MB; Dornan, GJ; Schmoelz, W; Turnbull, TL; Plecko, M; Kralinger, FS; Millett, PJ.
Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the "proximal anchoring point".
Int Orthop. 2017; 41(9): 1715-1721. [OPEN ACCESS]
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Autor/innen der Med Uni Graz:
Plecko Michael
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Abstract:
Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this "proximal anchoring point" (PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture. Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20° abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200-1.000 N) compared to those without the PAP (median, 325 N; range, 100-500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200-650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200-600 N; p = 0.240). The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the "proximal anchoring point's" rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.
Find related publications in this database (using NLM MeSH Indexing)
Aged -
Aged, 80 and over -
Biomechanical Phenomena -
Bone Nails - adverse effects
Cadaver -
Female -
Fracture Dislocation - surgery
Fracture Fixation, Intramedullary - adverse effects
Fracture Fixation, Intramedullary - methods
Humans -
Humeral Head - surgery
Male -
Shoulder Fractures - surgery

Find related publications in this database (Keywords)
Humeral fracture
Straight antegrade nails
Proximal anchoring point
Stability
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