Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft
Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft
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DOI：
10.1016/j.jse.2011.04.015
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发表时间：
2012-07-01
影响因子：
3
通讯作者：
Bouliane, Martin J.
中科院分区：
文献类型：
--
作者：
Chow, Roxanne M.;Begum, Farhana;Bouliane, Martin J.
工作背景：肱骨近端骨折锁定钢板结构可能由于内翻塌陷而失败，尤其是在内侧皮质粉碎的骨质疏松骨中。使用腓骨同种异体移植物作为髓内骨钉进行增强，可以加强固定，防止内翻塌陷。本研究调查了增强锁定钢板结构相对于非增强结构承受重复内翻应力的能力。材料和方法：通过在尸体标本的外科颈处进行楔形截骨来模拟伴有内侧粉碎的肱骨近端骨折。对于每具尸体（n = 8），1例肱骨骨折仅使用锁定钢板结构固定，另1例使用锁定钢板结构加同侧腓骨自体移植物加固。肱骨头被固定和重复，内侧方向的负载施加到肱骨干，直到结构崩溃或直到25000个cycle were completed.Results：没有增加结构崩溃。相比之下，8个非增强结构中有6个塌陷（P <0.05）。6个非增强结构在平均+/- SD 6604 +/- 1984次循环后发生塌陷。仅在1个未加固结构中发现关节面螺钉穿透。结论：腓骨同种异体移植物加固增加了锁定钢板承受重复内翻载荷的能力。在临床上，这可能有助于肱骨近端骨折内固定在骨质疏松骨内侧皮质粉碎。证据等级：基础科学研究，生物力学研究。皇冠版权所有（C）2012年出版的杂志肩肘外科董事会。
Background: Locking plate constructs for proximal humeral fractures can fail due to varus collapse, especially in osteoporotic bone with medial cortex comminution. Augmentation, using a fibular allograft as an intramedullary bone peg, may strengthen fixation preventing varus collapse. This study investigated the ability of the augmented locking plate construct to withstand repetitive varus stresses relative to the nonaugmented construct.Materials and methods: Proximal humeral fractures with medial comminution were simulated by performing wedge-shaped osteotomies at the surgical neck in cadaveric specimens. For each cadaver (n = 8), 1 humeral fracture was fixated with the locking plate construct alone and the other with the locking plate construct plus ipsilateral fibular autograft augmentation. The humeral head was immobilized and a repetitive, medially directed load was applied to the humeral shaft until construct collapse or until 25000 cycles were completed.Results: No augmented construct collapsed. In comparison, 6 of 8 nonaugmented constructs collapsed (P < .05). Collapse in the 6 nonaugmented constructs occurred after an average +/- SD of 6604 +/- 1984 cycles. Screw penetration of the articular surface was found in only 1 of the nonaugmented constructs.Conclusion: Fibular allograft augmentation increased the ability of the locking plate to withstand repetitive varus loading. Clinically, this may assist proximal humeral fracture fixation in osteoporotic bone with medial cortex comminution.Level of evidence: Basic Science Study, Biomechanical Study. Crown Copyright (C) 2012 Published by Journal of Shoulder and Elbow Surgery Board of Trustees.