Dual plating of humeral shaft fractures: orthogonal plates biomechanically outperform side-by-side plates.
BACKGROUND
Single large-fragment plate constructs currently are the norm for internal fixation of middiaphyseal humerus fractures. In cases where humeral size is limited, however, dual small-fragment locking plate constructs may serve as an alternative. The mechanical effects of different possible plate configurations around the humeral diaphysis may be important, but to our knowledge, have yet to be investigated.


OBJECTIVE
We used finite element analysis to compare the simulated mechanical performance of five different dual small-fragment locking plate construct configurations for humeral middiaphyseal fracture fixation in terms of (1) stiffness, (2) stress shielding of bone, (3) hardware stresses, and (4) interfragmentary strain.


METHODS
Middiaphyseal humeral fracture fixation was simulated using the finite element method. Three 90° and two side-by-side seven-hole and nine-hole small-fragment dual locking plate configurations were tested in compression, torsion, and combined loading. The configurations chosen are based on implantation using either a posterior or anterolateral approach.


RESULTS
All three of the 90° configurations were more effective in restoring the intact compressive and torsional stiffness as compared with the side-by-side configurations, resulted in less stress shielding and stressed hardware, and showed interfragmentary strains between 5% to 10% in torsion and combined loading.


CONCLUSIONS
The nine-hole plate anterior and seven-hole plate lateral (90° apart) configuration provided the best fixation. Our findings show the mechanical importance of plate placement with relation to loading in dual-plate fracture-fixation constructs.


CONCLUSIONS
The results presented provide novel biomechanical information for the orthopaedic surgeon considering different treatment options for middiaphyseal humeral fractures.
Bone and Joint Research Center, Department of Orthopaedic Surgery, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard (CBH 407), Fort Worth, TX, 76107, USA, victor.kosmopoulos@yahoo.com.
Victor
V
Kosmopoulos
Arvind D
AD
Nana
D000328:Adult; D001696:Biomechanical Phenomena; D001860:Bone Plates; D019245:Compressive Strength; D003198:Computer Simulation; D020342:Finite Element Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D006810:Humeral Fractures / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006811:Humerus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008422:Materials Testing; D011474:Prosthesis Design; D013314:Stress, Mechanical; D054159:Torsion, Mechanical; D016474:Weight-Bearing