Humeral head reconstruction for Hill-Sachs defects: a biomechanical comparison of 2 fixation techniques for bone grafting.
OBJECTIVE
The purpose of this biomechanical study was to compare anterograde with retrograde screw fixation for allograft reconstruction of Hill-Sachs defects.


METHODS
In 8 pairs of fresh-frozen humeral heads, a 40% Hill-Sachs defect was created. The resultant wedge-shaped osteochondral fragment was used as allograft. For each technique, two 3.75-mm screws were used for fixation. To test the strength of fixation, a custom tool was used that would apply load to the graft. By use of a materials testing machine, a staircase cyclic loading protocol was performed (500 cycles at 10, 20, 30, and 40 N) and then load to failure. Graft displacement was measured by an optical tracking system.


RESULTS
For the 2 techniques, graft displacement increased with increasing load and increasing number of cycles up to a mean of 0.9 ± 0.42 mm for anterograde fixation and 1.1 ± 0.79 mm for retrograde fixation. This increase was significant within each technique across all 4 loading levels (P < .05). However, there were no significant differences in graft displacement between the 2 techniques at any loading level or number of cycles (P = .16 to P = .96). In addition, the load to failure between the anterograde and retrograde techniques (98.5 N and 95.6 N, respectively) was not significantly different (P = .706).


CONCLUSIONS
The initial fixation and failure strength of anterograde and retrograde graft fixation techniques for substantial Hill-Sachs defects do not significantly differ in a biomechanical cadaveric model.


CONCLUSIONS
This biomechanical study supports that in an engaging Hill-Sachs defect, both anterograde and retrograde screw fixation techniques can be used for fixation of humeral head allografts.
Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Gabor J
GJ
Puskas
Hand and Upper Limb Centre, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada.
Joshua W
JW
Giles
Hand and Upper Limb Centre, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada.
Ryan M
RM
Degen
Hand and Upper Limb Centre, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada.
James A
JA
Johnson
Hand and Upper Limb Centre, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada. Electronic address: gathwal@uwo.ca.
George S
GS
Athwal
D000368:Aged; D001134:Arm Injuries / Q000503:physiopathology* / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology* / Q000601:surgery*; D011859:Radiography; D016474:Weight-Bearing