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Comparative Study
. 2024 Dec 26;25(1):1066.
doi: 10.1186/s12891-024-08216-0.

Biomechanical study of two different fixation methods for the treatment of Neer III proximal humerus fractures

Bangjun Cheng #  1 , Xiping Jiang #  2 , Xiaofeng Zhang #  1 , Shixin Guo  1 , Qi Chen  1 , Shengchao Du  1 , Yi Luo  3 , Yaohua He  4   5
Affiliations
Comparative Study

Biomechanical study of two different fixation methods for the treatment of Neer III proximal humerus fractures

Bangjun Cheng et al. BMC Musculoskelet Disord. .

Abstract

Background: The lateral locking plate for the proximal humerus is currently the most commonly used surgical procedure for the treatment of elderly proximal humeral comminuted fractures. Previous studies have found that the rate of postoperative complications in patients of proximal humerus fractures with medial column involvement is relatively high. Through biomechanical methods, this study aims to investigate the effectiveness of the conventional lateral locking plate fixation along with the addition of the metacarpal supporting plate on the medial column in the treatment for proximal humeral fractures involving the medial column. The goal is to reduce the rate of postoperative internal fixation failure in patients with medial column injury.

Methods: Thirty artificial synthetic humerus models are used as experimental samples. A proximal humerus fracture model with medial column injury was created, and then divided into two groups. Group A was fixed with a proximal humerus lateral locking plate (single-plate group). Group B was fixed with a proximal humerus lateral locking plate and a metacarpal supporting plate on the medial column (double-plate group). The failure displacement, stiffness, and strength of the repaired proximal humerus fractures with two different methods were tested under compression at posterior extension of 15°, forward flexion of 15°, and vertical direction.

Results: There was no statistical significance in the comparison of the failure displacement of repaired proximal humeral fractures between the two groups under compression at posterior extension of 15° and forward flexion of 15° (P > 0.05). However, the failure displacement of the fracture was longer in single-plate group than in double-plate group under compression at vertical direction (P < 0.05). The double-plate group was better in terms of biomechanical stiffness and strength compared to the single-plate group at all three testing angles (P < 0.05).

Conclusions: For patients whose proximal humeral fractures involve the medial column, the addition of a support plate on the medial side of the humerus is recommended along with the lateral locking plate. The double-plate strategy can increase the stability of the medial column of the proximal humerus, and enhance the overall biomechanical property of the repaired proximal humerus.

Keywords: Biomechanical property; Lateral locking plate; Metacarpal supporting plate; Proximal humeral fractures.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board (IRB) of Jinshan District Central Hospital (No. jszxyy202120). No human tissue or specimen were involved in this study. There was no human participant in this study. Artificial bone models were applied for all the experiments. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Two models of fractures with different fixation methods and different compression angles. (A) Proximal humerus lateral locking plate model. (B-D) Proximal humerus lateral locking plate model at vertical direction, forward flexion of 15°, and posterior extension of 15°. (E) Proximal humerus lateral locking plate and medial metacarpal supporting plate model. (F-G) The proximal humerus lateral locking plate and medial metacarpal supporting plate model at vertical direction, forward flexion of 15°, and posterior extension of 15°
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