Parameterization of Proximal Humerus Locking Plate Impingement with In Vitro, In Silico, and In Vivo Techniques
| Autor: | Surena Namdari, Josh R. Baxter, Emily M. Bachner, Michael W. Hast, Elaine C. Schmidt, Matthew Chine |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Proximal humerus Rotation Computer science Movement Locked plating Locking plate Fracture Fixation Internal Young Adult 03 medical and health sciences 0302 clinical medicine Subacromial impingement Activities of Daily Living Cadaver Humans Medicine Computer Simulation Orthopedics and Sports Medicine Acromion Instant centre of rotation Fixation (histology) Aged Orthodontics 030222 orthopedics Preoperative planning Shoulder Joint business.industry 030229 sport sciences General Medicine In vitro experiment Biomechanical Phenomena Implant placement medicine.anatomical_structure Tilt (optics) Shoulder Impingement Syndrome Humeral Head Shoulder Fractures Female Surgery Implant Cadaveric spasm business Bone Plates |
| DOI: | 10.1101/368258 |
| Popis: | BackgroundLocked plating of displaced proximal humerus fractures is common, but rates of subacromial impingement remain high. Computational predictions of implant impingement have yet to be sufficiently explored in proximal humerus fixation. The goal of this study was to utilize a multidisciplinary approach to elucidate the relationships between common surgical parameters, anatomical variability, and the likelihood of plate impingement.MethodsThe experiment was completed in three phases. First, a controlled in vitro experiment was conducted to simulate impingement. Second, a dynamic in silico musculoskeletal model was developed to simulate changes to implant geometry, surgical techniques, and acromial anatomy, where a collision detection algorithm was used to simulate contact between the plate and acromion. Finally, in vivo shoulder kinematics were recorded for nine activities of daily living and motions that created a high likelihood of impingement were identified.ResultsImpingement was measured at 73.3±14.5° abduction in the cadaveric model and 92.0°±34.0° with computational simulations. Impingement events were limited to ranges of motion between 10–40° of cross-body adduction. Activities of daily living, such as combing one’s hair, lifting and object overhead, and reaching behind one’s head are likely to cause impingement.Discussion and ConclusionThis multidisciplinary experiment quantified key preoperative factors to assist with implantation decisions. Results demonstrated that proximal implant placement, superior translation of the humeral center of rotation, increases in plate thickness, and increases in acromial tilt all increase the likelihood of impingement. Careful preoperative planning that includes these factors could help guide operative decision making and improve clinical outcomes.Level of Evidence: V |
| Databáze: | OpenAIRE |
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