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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 8/2019

01-08-2019 | Trauma Surgery

The influence of screw length on predicted cut-out failures for proximal humeral fracture fixations predicted by finite element simulations

Authors: James W. A. Fletcher, Markus Windolf, Leonard Grünwald, R. Geoff Richards, Boyko Gueorguiev, Peter Varga

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2019

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Abstract

Background

The aim of this study was to identify the effect of screw length on predictions of fixation failure in three-part proximal humeral fractures using a finite element-based osteosynthesis modelling toolkit.

Methods

A mal-reduced unstable three-part AO/OTA 11-B3.2 fracture with medial comminution was simulated in forty-two digitally processed proximal humeri covering a spectrum of bone densities and fixed with the PHILOS plate using three distal and six proximal locking screws. Four test groups were generated based on the screw tip to joint surface distance (TJD), with all proximal screws being shortened from 4 mm TJD to be 8, 12 or 16 mm TJD. Average bone strains around the screw tips, correlating with biomechanical cyclic cut-out-type failure, were evaluated in three physiological loading protocols representing simple shoulder motions. Six further groups were tested, where five of the proximal screws were inserted to 4 mm TJD and the sixth screw to 8 mm TJD.

Results

Exponential increases in the predicted risk of fixation failure were seen with increased tip-to-joint distances (p < 0.001). When one of the proximal screws was placed 8 mm from the joint, with the remaining five at 4 mm distance, significant increases (p < 0.001) were registered in the strains around the screw tips in all except the two superior screws. This effect was maximal around the calcar screws (p < 0.001) and for lower density samples (p < 0.001).

Conclusions

These results suggest that longer screws provide reduced risk of cut-out failure, i.e. distalisation and/or varisation of the head fragment, and thus may decrease failure rates in proximal humeral fractures treated with angular stable plates. These findings require clinical corroboration and further studies to investigate the risk of screw perforation.
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Metadata
Title
The influence of screw length on predicted cut-out failures for proximal humeral fracture fixations predicted by finite element simulations
Authors
James W. A. Fletcher
Markus Windolf
Leonard Grünwald
R. Geoff Richards
Boyko Gueorguiev
Peter Varga
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 8/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-019-03175-x

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