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. 2023 Sep 27;13(1):16250.
doi: 10.1038/s41598-023-43183-x.

Biomechanical performance evaluation of a modified proximal humerus locking plate for distal humerus shaft fracture using finite element analysis

Jung-Soo Lee  1   2   3 , Kwang Gi Kim #  4   5   6 , Yong-Cheol Yoon #  7
Affiliations

Biomechanical performance evaluation of a modified proximal humerus locking plate for distal humerus shaft fracture using finite element analysis

Jung-Soo Lee et al. Sci Rep. .

Abstract

The extra-articular distal humerus plate (EADHP) has been widely used for surgical treatment of distal humerus shaft fracture (DHSF). However, the surgical approach, fixation methods, and implant positions of the EADHP remain controversial owing to iatrogenic radial nerve injury and complaints such as skin irritation related to the plate. Anterior plating with a modified (upside-down application) proximal humerus locking plate (PHILOS) has been proposed as an alternative, However, research on its biomechanical performance remain insufficient and were mostly based on retrospective studies. This study quantitatively compared and evaluated the biomechanical performance between posterior plating with the EADHP and anterior plating with a modified PHILOS using finite element analysis (FEA). The FEA simulation results that both the EADHP and PHILOS had adequate biomechanical performance and stability under axial, bending, and varus force load conditions. The PHILOS has a fixed stability comparable to that of the EADHP, and fixation was achieved using only four locking screws within a fixed range of 30 mm just above the olecranon fossa. The results show that the PHILOS could be an option for the fixation of a DHSF when considering the dissection range and complaints (e.g. skin irritation) associated with the EADHP.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
(a) Overall preprocessing; 3D reconstruction of distal humerus. Image review platform (AVIEW Research Build 1.1.42.12, Coreline Soft Inc., https://www.corelinesoft.com/research) was used for the region of interest (ROI) about the shape of the cortical bone. Also, Meshmixer ver. 3.5 (Autodesk, Inc., https://meshmixer.softonic.kr) program was used for smoothing and rendering. (b) 3D CAD model of 10 mm gap, distal humerus shaft fracture (DHSF), extra-articular distal humerus plate (EADHP), proximal humerus locking plate (PHILOS), and details on finite element models. (c) Three types of applied loads. Ansys Workbench 2022 R2 (ANSYS, Inc., Canonsburg, PA, USA, https://www.ansys.com) used for 3D modeling and of pre-process of finite element analysis (FEA).
Figure 2
Figure 2
Maximum von-Mises stress on the plate under axial force condition. Ansys Workbench 2022 R2 (ANSYS, Inc., Canonsburg, PA, USA, https://www.ansys.com) used for finite element analysis (FEA) simulations.
Figure 3
Figure 3
Maximum von-Mises stress on the humerus under bending force condition. Ansys Workbench 2022 R2 (ANSYS, Inc., Canonsburg, PA, USA, https://www.ansys.com) used for finite element analysis (FEA) simulations.
Figure 4
Figure 4
Maximum von-Mises stress on the locking screws under varus force condition. Ansys Workbench 2022 R2 (ANSYS, Inc., Canonsburg, PA, USA, https://www.ansys.com) used for finite element analysis (FEA) simulations.
See this image and copyright information in PMC

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