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Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation
Martin Henri Hessmann1, Werner Sternstein Matthias Hansen, Frank Krummenauer
1Department of Trauma Surgery, Johannes Gutenberg-University, Langenbeckstrasse 1, D-55101 Mainz, Germany. Hessmann@unfall.klinik.uni-mainz.de
Background:
Internal fixation of proximal humeral fractures is associated with a considerable secondary malalignment rate. Fixed-angle implants have been suggested to increase the stability of fixation.
Methods:
The biomechanical properties of four different implants were tested. These included an internal fixator with semi-elastic properties (reference), the Synthes T-plate, a locked plate with rigid properties and a spiral blade locked intramedullary nail (PHN). These implants were assessed in twenty-four osteotomized pairs of human cadaveric humeri. Specimens were subjected to two-hundred cycles of axial loading and torque followed by load to failure.
Results:
The PHN had greater axial stiffness than the reference and the T-plate. During torque, all implants were stiffer than the reference. During cyclic loading, there were no differences between the T-plate and the reference. Both the rigid internal fixator and the PHN had less irreversible deformation than the reference. Both implants resisted higher loads before failure.
Conclusion:
This study showed that the proximal humeral nail and the rigid internal fixator are stronger than the semi-elastic locked plate and the Synthes T-plate for unstable subcapital proximal humeral fractures.
