title: [Augmentation technique on the proximal humerus].
abstract: OBJECTIVE
  The treatment of osteoporotic fractures is still a challenge. The advantages of augmentation with respect to primary in vitro stability and the clinical use for the proximal humerus are presented in this article.
  
  
  METHODS
  In this study six paired human humeri were randomized into an augmented and a non-augmented group. Osteosynthesis was performed with a PHILOS plate (Synthes®). In the augmented group the two screws finding purchase in the weakest cancellous bone were augmented. The specimens were tested in a 3-part fracture model in a varus bending test.
  
  
  RESULTS
  The augmented PHILOS plates withstood significantly more load cycles until failure. The correlation to bone mineral density (BMD) showed that augmentation could partially compensate for low BMD.
  
  
  CONCLUSIONS
  The augmentation of the screws in locked plating in a proximal humerus fracture model is effective in improving the primary stability in a cyclic varus bending test. The targeted augmentation of two particular screws in a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. The technique of augmentation is simple and can be applied in open and minimally invasive procedures. When the correct procedure is used, complications (cement leakage into the joint) can be avoided.
authors: Zentrum für Chirurgie, Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Deutschland, alexander.scola@uniklinik-ulm.de.
authors: A
authors: A
authors: Scola
authors: F
authors: F
authors: Gebhard
authors: G
authors: G
authors: Röderer
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D001860:Bone Plates; D060826:Cementoplasty / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D019544:Equipment Failure Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000628:therapy*; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012784:Shoulder Fractures / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements