Role of inferomedial supporting screws for secondary varus deformity in non-osteoporotic proximal humerus fracture: A biomechanical study.

Abstract

The purpose of this study was to evaluate the effect of a medial support screw through a proximal humerus fracture. For this purpose, we verified whether the biomechanics are different according to the position of the screw while using the same number of screws. In addition, we tried to verify whether the insertion of additional inferomedial screws would make a difference in stability. Twenty-four proximal humerus bones were included in the study. A two-part fracture was created and fixed using a locking plate. Cyclic loading and load-to-failure test were applied to three groups: group A (proximal 6 screws + calcar screws), group B (proximal 6 screws), and group C (proximal 4 screws + calcar screws). Interfragmentary gaps were measured following cyclic loading and compared. The failure was defined when the bone breakage or medial gap closing was observed during ultimate failure load applied. The load-to-failure, maximum displacement, stiffness, and yield load were recorded and compared. The interfragmentary gap was differently reduced by 0.29 ± 0.14mm, 0.73 ± 0.25mm, and 0.53 ± 0.09mm following 1000 cyclic loading for groups A, B, and C, respectively. The load-to-failure was 945.22 ± 101.02N, 941.40 ± 148.90N, and 940.58 ± 91.78N in groups A, B, and C, respectively. The stiffness of group A (214.76 ± 34.0N/mm) was superior when compared to that of group C (171.12 ± 23.0N/mm; p = 0.025). The maximum displacement prior to failure, yield load, showed no significant difference between comparative groups. Our study did not show any additional biomechanical effects with the use of inferomedial supporting screws in non-osteoporotic proximal humerus fracture, besides making the fracture-plate construct stiff. The role of the inferomedial supporting screw was also unclear. However, the groups that used increased screw fixation and inferomedial screw insertion seemed to be more resistant to cyclic loading.