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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

22.12.2016 | Trauma Surgery

PEEK versus titanium locking plates for proximal humerus fracture fixation: a comparative biomechanical study in two- and three-part fractures

verfasst von: Benedikt Schliemann, Robert Seifert, Christina Theisen, Dominic Gehweiler, Dirk Wähnert, Martin Schulze, Michael J. Raschke, Andre Weimann

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 1/2017

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Abstract

Introduction

The high rigidity of metal implants may be a cause of failure after fixation of proximal humerus fractures. Carbon fiber-reinforced polyetheretherketone (PEEK) plates with a modulus similar to human cortical bone may help to overcome this problem. The present study assesses the biomechanical behavior of a PEEK plate compared with a titanium locking plate.

Materials and methods

Unstable two- and three-part fractures were simulated in 12 pairs of cadaveric humeri and were fixed with either a PEEK or a titanium locking plate using a pairwise comparison. With an optical motion capture system, the stiffness, failure load, plate bending, and the relative motion at the bone–implant interface and at the fracture site were evaluated.

Results

The mean load to failure for two- and three-part fracture fixations was, respectively, 191 N (range 102–356 N) and 142 N (range 102–169 N) in the PEEK plate group compared with 286 N (range 191–395 N) and 258 N (range 155–366 N) in the titanium locking plate group. The PEEK plate showed significantly more bending in both the two- and three-part fractures (p < 0.05), an increased relative motion at the bone–implant interface and lower stiffness values (p < 0.05).

Conclusion

In this biomechanical study on unstable proximal humerus fractures, fixation with a PEEK plate showed lower fixation strength and increased motion at the bone–implant interface compared with a titanium locking plate.

Bell JE, Leung BC, Spratt KF, Koval KJ, Weinstein JD, Goodman DC, Tosteson AN (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Jt Surg Am 93(2):121–131. doi:10.2106/JBJS.I.01505 CrossRef

Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore M, Saag K (2011) Which fractures are most attributable to osteoporosis? J Clin Epidemiol 64(1):46–53. doi:10.1016/j.jclinepi.2010.07.007 CrossRefPubMedPubMedCentral

Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92CrossRefPubMed

Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, Nicholson GP, Romeo AA (2014) Surgical management of complex proximal humerus fractures—a systematic review of 92 studies including 4500 patients. J Orthop Trauma. doi:10.1097/BOT.0000000000000229

Schliemann B, Siemoneit J, Theisen C, Kösters C, Weimann A, Raschke MJ (2012) Complex fractures of the proximal humerus in the elderly—outcome and complications after locking plate fixation. Musculoskelet Surg 96(Suppl 1):S3–S11. doi:10.1007/s12306-012-0181-8 CrossRefPubMed

Sproul RC, Iyengar JJ, Devcic Z, Feeley BT (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42(4):408–413. doi:10.1016/j.injury.2010.11.058 CrossRefPubMed

Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg 18(6):837–844. doi:10.1016/j.jse.2009.06.004 CrossRefPubMed

Maldonado ZM, Seebeck J, Heller MO, Brandt D, Hepp P, Lill H, Duda GN (2003) Straining of the intact and fractured proximal humerus under physiological-like loading. J Biomech 36(12):1865–1873CrossRefPubMed

Gardner MJ, Nork SE, Huber P, Krieg JC (2010) Less rigid stable fracture fixation in osteoporotic bone using locked plates with near cortical slots. Injury 41(6):652–656. doi:10.1016/j.injury.2010.02.022 CrossRefPubMed

10.

Epari DR, Kassi JP, Schell H, Duda GN (2007) Timely fracture-healing requires optimization of axial fixation stability. J Bone Jt Surg Am 89(7):1575–1585. doi:10.2106/JBJS.F.00247

11.

Brunner A, Resch H, Babst R, Kathrein S, Fierlbeck J, Niederberger A, Schmolz W (2012) The Humerusblock NG: a new concept for stabilization of proximal humeral fractures and its biomechanical evaluation. Arch Orthop Trauma Surg 132(7):985–992. doi:10.1007/s00402-012-1503-x CrossRefPubMed

12.

Brunner A, Weller K, Thormann S, Jockel JA, Babst R (2010) Closed reduction and minimally invasive percutaneous fixation of proximal humerus fractures using the Humerusblock. J Orthop Trauma 24(7):407–413. doi:10.1097/BOT.0b013e3181c81b1c CrossRefPubMed

13.

Kralinger F, Gschwentner M, Wambacher M, Smekal V, Haid C (2008) Proximal humeral fractures: what is semi-rigid? Biomechanical properties of semi-rigid implants, a biomechanical cadaver based evaluation. Arch Orthop Trauma Surg 128(2):205–210. doi:10.1007/s00402-007-0512-7 CrossRefPubMed

14.

Steinberg EL, Rath E, Shlaifer A, Chechik O, Maman E, Salai M (2013) Carbon fiber reinforced PEEK optima—a composite material biomechanical properties and wear/debris characteristics of CF-PEEK composites for orthopedic trauma implants. J Mech Behav Biomed Mater 17:221–228. doi:10.1016/j.jmbbm.2012.09.013 CrossRefPubMed

15.

Röderer G, Scola A, Schmolz W, Gebhard F, Windolf M, Hofmann-Fliri L (2013) Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures. Injury 44(10):1327–1332. doi:10.1016/j.injury.2013.05.008 CrossRefPubMed

16.

Unger S, Erhart S, Kralinger F, Blauth M, Schmoelz W (2012) The effect of in situ augmentation on implant anchorage in proximal humeral head fractures. Injury 43(10):1759–1763. doi:10.1016/j.injury.2012.07.003 CrossRefPubMed

17.

Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123(2–3):74–81. doi:10.1007/s00402-002-0465-9 PubMed

18.

Bottlang M, Doornink J, Byrd GD, Fitzpatrick DC, Madey SM (2009) A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis. J Bone Jt Surg Am 91(3):620–627. doi:10.2106/JBJS.H.00408 CrossRef

19.

Dietrich M, Meier C, Lattmann T, Zingg U, Gruninger P, Platz A (2008) Complex fracture of the proximal humerus in the elderly. Locking plate osteosynthesis vs hemiarthroplasty. Chirurg 79(3):231–240. doi:10.1007/s00104-007-1436-z CrossRefPubMed

20.

Schliemann B, Hartensuer R, Koch T, Theisen C, Raschke MJ, Kösters C, Weimann A (2015) Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year-results of a prospective study and comparison to fixation with a conventional locking plate. J Shoulder Elbow Surg 24(8):1282–1288. doi:10.1016/j.jse.2014.12.028 CrossRefPubMed

21.

Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42(11):1283–1288. doi:10.1016/j.injury.2011.01.017 CrossRefPubMed

22.

Owsley KC, Gorczyca JT (2008) Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Jt Surg Am 90(2):233–240. doi:10.2106/JBJS.F.01351 CrossRef

23.

Katthagen JC, Schwarze M, Meyer-Kobbe J, Voigt C, Hurschler C, Lill H (2014) Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures. Clin Biomech (Bristol, Avon) 29(7):735–741. doi:10.1016/j.clinbiomech.2014.06.008 CrossRef

24.

Zhang L, Zheng J, Wang W, Lin G, Huang Y, Zheng J, Edem Prince GA, Yang G (2011) The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop 35(11):1655–1661. doi:10.1007/s00264-011-1227-5 CrossRefPubMedPubMedCentral

25.

Zhang W, Zeng L, Liu Y, Pan Y, Zhang W, Zhang C, Zeng B, Chen Y (2014) The mechanical benefit of medial support screws in locking plating of proximal humerus fractures. PLoS One 9(8):e103297. doi:10.1371/journal.pone.0103297 CrossRefPubMedPubMedCentral

26.

Schliemann B, Seifert R, Rosslenbroich SB, Theisen C, Wahnert D, Raschke MJ, Weimann A (2015) Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures. J Shoulder Elbow Surg 4(12):1968–1973. doi:10.1016/j.jse.2015.06.028 CrossRef

27.

Kathrein S, Kralinger F, Blauth M, Schmoelz W (2013) Biomechanical comparison of an angular stable plate with augmented and non-augmented screws in a newly developed shoulder test bench. Clin Biomech (Bristol, Avon) 28(3):273–277. doi:10.1016/j.clinbiomech.2012.12.013 CrossRef

28.

Roderer G, Gebhard F, Krischak G, Wilke HJ, Claes L (2011) Biomechanical in vitro assessment of fixed angle plating using a new concept of locking for the treatment of osteoporotic proximal humerus fractures. Int Orthop 35(4):535–541. doi:10.1007/s00264-010-1021-9 CrossRefPubMed

29.

Euler SA, Hengg C, Wambacher M, Spiegl UJ, Kralinger F (2014) Allogenic bone grafting for augmentation in two-part proximal humeral fracture fixation in a high-risk patient population. Arch Orthop Trauma Surg. doi:10.1007/s00402-014-2128-z

30.

Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21(3):185–191. doi:10.1097/BOT.0b013e3180333094 CrossRefPubMed

31.

Neviaser AS, Hettrich CM, Beamer BS, Dines JS, Lorich DG (2011) Endosteal strut augment reduces complications associated with proximal humeral locking plates. Clin Orthop Relat Res 469(12):3300–3306. doi:10.1007/s11999-011-1949-0 CrossRefPubMedPubMedCentral

32.

Somasundaram K, Huber CP, Babu V, Zadeh H (2013) Proximal humeral fractures: the role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates. Injury 44(4):481–487. doi:10.1016/j.injury.2012.10.030 CrossRefPubMed

33.

Tan E, Lie D, Wong MK (2014) Early outcomes of proximal humerus fracture fixation with locking plate and intramedullary fibular strut graft. Orthopedics 37(9):e822–e827. doi:10.3928/01477447-20140825-60 CrossRefPubMed

34.

Zhu L, Liu Y, Yang Z, Li H, Wang J, Zhao C, Chen X, Zhang Y (2014) Locking plate fixation combined with iliac crest bone autologous graft for proximal humerus comminuted fracture. Chin Med J 127(9):1672–1676PubMed

35.

Westerhoff P, Graichen F, Bender A, Halder A, Beier A, Rohlmann A, Bergmann G (2009) In vivo measurement of shoulder joint loads during activities of daily living. J Biomech 42(12):1840–1849. doi:10.1016/j.jbiomech.2009.05.035 CrossRefPubMed

36.

Katthagen JC, Schwarze M, Warnhoff M, Voigt C, Hurschler C, Lill H (2016) Influence of plate material and screw design on stiffness and ultimate load of locked plating in osteoporotic proximal humeral fractures. Injury 47(3):617–624. doi:10.1016/j.injury.2016.01.004 CrossRefPubMed

Titel: PEEK versus titanium locking plates for proximal humerus fracture fixation: a comparative biomechanical study in two- and three-part fractures
verfasst von: Benedikt Schliemann
Robert Seifert
Christina Theisen
Dominic Gehweiler
Dirk Wähnert
Martin Schulze
Michael J. Raschke
Andre Weimann
Publikationsdatum: 22.12.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 1/2017
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2620-8

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Abstract

Introduction

Materials and methods

Results

Conclusion

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