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Open Access 01-09-2017 | Original Paper

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Authors: Simon A. Euler, Maximilian Petri, Melanie B. Venderley, Grant J. Dornan, Werner Schmoelz, Travis Lee Turnbull, Michael Plecko, Franz S. Kralinger, Peter J. Millett

Published in: International Orthopaedics | Issue 9/2017

Abstract

Purpose

Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this “proximal anchoring point” (PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP.

Methods

Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture.

Results

Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20° abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200–1.000 N) compared to those without the PAP (median, 325 N; range, 100–500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200–650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200–600 N; p = 0.240).

Conclusions

The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the “proximal anchoring point’s” rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.

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Title: Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”
Authors: Simon A. Euler
Maximilian Petri
Melanie B. Venderley
Grant J. Dornan
Werner Schmoelz
Travis Lee Turnbull
Michael Plecko
Franz S. Kralinger
Peter J. Millett
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3498-y

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Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Abstract

Purpose

Methods

Results

Conclusions

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Abstract

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