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Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra-articular diaphyseal humeral fractures

Authors
 Joon-Ryul Lim  ;  Tae-Hwan Yoon  ;  Yun-Rak Choi  ;  Hwan-Mo Lee  ;  Yong-Min Chun 
Citation
 JOURNAL OF ORTHOPAEDIC RESEARCH, Vol.39(9) : 1877-1883, 2021-09 
Journal Title
JOURNAL OF ORTHOPAEDIC RESEARCH
ISSN
 0736-0266 
Issue Date
2021-09
Keywords
EADHP ; PHILOS ; biomechanical testing ; distal humeral fracture ; locking plate fixation
Abstract
The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: the modified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.
Full Text
https://onlinelibrary.wiley.com/doi/10.1002/jor.24925
DOI
10.1002/jor.24925
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
Lim, Joon Ryul(임준열) ORCID logo https://orcid.org/0000-0002-0123-7136
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
Choi, Yun Rak(최윤락)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187167
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