Reconstruction of proximal humeral fractures with a reduced number of screws and a reinforced bone substitute
| Autor: | Enrico Guerra, Marco Cavallo, Luca Cristofolini, Kavin Morellato |
|---|---|
| Přispěvatelé: | Cristofolini L., Morellato K., Cavallo M., Guerra E. |
| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
Materials science Bone substitute Bone Screws 0206 medical engineering Biomedical Engineering Biophysics 02 engineering and technology Augmentation Locking plate Fracture Fixation Internal 03 medical and health sciences Number of screw 0302 clinical medicine Cadaver medicine Humans Humerus Proximal humeral fracture Cartilage damage Orthodontics musculoskeletal system Biomechanical test 020601 biomedical engineering Standard technique Biomechanical Phenomena Osteoporotic multi-fragment fracture medicine.anatomical_structure Bone Substitutes Shoulder Fractures Osteoporotic bone Bone Plates Cancellous bone 030217 neurology & neurosurgery |
| Zdroj: | Medical Engineering & Physics. 82:97-103 |
| ISSN: | 1350-4533 |
| DOI: | 10.1016/j.medengphy.2020.06.002 |
| Popis: | Multi-fragmented fractures of the proximal humerus are difficult to treat, especially in the case of osteoporotic bone. Intra-operative risks include cartilage damage when inserting multiple screws. A common post-operative complication is distal-varus collapse of the head. The aim of this study was to investigate if an Innovative technique (reduced number of screws and injection of a beta-TCP additivated partially resorbable cement) provides the same or better stability of the reconstructed head compared to the Standard technique (using more screws). A four-fragment fracture was simulated in six pairs of humeri, with partial removal of the cancellous bone to simulate osteoporotic “eggshell” defect. One humerus of each pair was repaired with a Standard (locking plate, 2 cortical and 6 locking screws), and the other with the Innovative technique (same plate, 2 cortical and only 3 locking screws, plus cement injection). The reconstructed specimens were subjected to a biomechanical test where a cyclic force of increasing amplitude was applied axially until failure. The Innovative reconstructions withstood a force 3.49 times larger than the contralateral Standard reconstructions before failure started. The maximum force before final collapse for the Innovative reconstructions was 4.24 times larger than the contralateral Standard reconstructions. These differences were statistically significant. The Innovative reconstructions, based on fewer screws and beta-TCP additivated acrylic cement, showed positive results, demonstrating better biomechanical properties compared to the Standard reconstructions. These laboratory findings, along with the advantages of a reduced number of screws, may help perform a surgically safer, and more effective procedure in osteoporotic patients. |
| Databáze: | OpenAIRE |
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