[Biomechanical investigation of fixed-angle plate osteosynthesis of the proximal humerus].
BACKGROUND
Proximal humeral fractures are common in the elderly population and are often associated with osteoporosis. Fixation of unstable proximal humeral fractures is problematic due to loss of fixation in osteoporotic bone. Fixed-angle devices are intended to provide superior mechanical stability due to the principle of an internal fixator. The NCB(R)-PH (non-contact-bridging proximal humerus) plate is a new fixed-angle device that locks the screws to the plate by secondary insertion of a locking cap. The aim of this study was to investigate if and to what extent NCB-PH plates applied in the locked mode provide higher mechanical stability in a proximal humerus fracture model.


METHODS
For this investigation 16 (8 pairs) fresh frozen cadaveric humeri were used. An AO/ASIF 11-B 1 fracture of the proximal humerus was created in each bone and fixed with the NCB-PH plate. In a paired setting one bone was fixed with the plate in the locked mode and the other with the plate in the non-locked mode. The bones were then subjected to 100 cycles of axial loading and interfragmentary motion was measured. Bones surviving this test were subjected to load-to-failure testing and the force at which failure occurred was recorded.


RESULTS
Bones fixed with the plate in the locked mode showed a statistically significant lower (51%) interfragmentary rotation compared to bones fixed with the plate in the non-locked mode. There was also a tendency for the bones fixed with the plate in the locked mode to fail first under higher forces (16%) during load-to-failure testing.


CONCLUSIONS
The NCB-PH plate provides superior interfragmentary stability when used in the locked mode in a human cadaveric proximal humerus fracture model. Therefore, we recommend that all screws should be inserted in the locked mode. The results suggest that the NCB-PH plate in the locked mode provides higher primary postoperative stability thus permitting early functional treatment of the patient.
Röderer
G
G
Zentrum für Chirurgie, Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universität Ulm, Steinhövelstr. 9, 89075, Ulm, Deutschland. goetz.roederer@uniklinik-ulm.de
AbouElsoud
M
M
Gebhard
F
F
Claes
L
L
Aschoff
A J
AJ
Kinzl
L
L
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016474:Weight-Bearing / Q000502:physiology