Pairs Of Humeri Research Articles

Sex differences in workload in medieval Poland: Patterns of asymmetry and biomechanical adaptation in the upper limb at Giecz.

This study characterizes sexual dimorphism in skeletal markers of upper limb mechanical loading due to lateralization as evidence of division of labor in medieval Giecz, Poland. Twenty-six dimensions for paired humeri, clavicles, and radii representing adult males (n = 89) and females (n = 53) were collected from a skeletal sample from the cemetery site Gz4. Percent directional asymmetry (DA) and absolute asymmetry (AA) for each dimension were compared among bones, osteometric subcategories, and sex. Additionally, side bias and sex differences were assessed in degenerative joint disease (DJD) and entheseal changes (ECs). Nearly all measurements revealed significant asymmetry favoring the right side. Asymmetry was most pronounced in midshaft dimensions with few sex differences. There were more correlations among dimensions within elements than between elements, mainly in the midshaft. No laterality in DJD frequencies was noted for either sex, but females demonstrated significantly lower odds of having DJD than males in most joints. Most ECs demonstrated a right-bias and association with DA with no sex-specific patterns except the biceps brachii insertion, where females were ~5 times more likely to be scored "right" than males. The general lack of sex differences in asymmetry and ECs suggests similarly demanding workloads for females and males, with the exception of sex-specific functional loading differences in the forearm. Further, DJD data suggest males engaged in more intensive activities involving the upper limb. These results enhance understanding of workload in this important historical period and provide a comparison for asymmetry in past populations.

Adjunctive fixation of the humeral epicondyle in a lateral condylar fracture model: Ex vivo comparison of pins and plates with a novel composite (AdhFix).

To compare the biomechanical properties of using a novel composite construct (AdhFix) to an interfragmentary Kirschner wire or a reconstruction plate as adjunctive epicondylar stabilization in simulated lateral unicondylar humeral fractures. Cadaveric biomechanical assessment. Paired humeri harvested from skeletally mature dogs (14-41 kg), nine cadavers per group. Simulated lateral unicondylar humeral fractures were stabilized with a transcondylar 4.5 mm cortical screw placed in lag fashion. Adjunct fixations consisting of a novel composite incorporating 2.7 mm cortical screws on one side, and either a 2.7 mm reconstruction plate or a 1.6 mm Kirschner wire on the contralateral side, were tested within paired humeri. Repaired humeri were axially loaded to failure and construct stiffness, yield load, and ultimate load were obtained from the load-deformation curves. In pairwise comparison, yield load was significantly higher for AdhFix group compared to the pin group, p = .016. No statistical significance was seen in the comparison between AdhFix group and the plate group, p = .25. Adhfix was mechanically superior to K-wires, and comparable to plate fixation, for adjunctive fixation in a lateral humeral condylar model. Our results support further investigation of the novel composite for adjunct fracture fixation in lateral humeral condylar fractures. The novel composite tested may be a viable alternative for adjunct fixation of humeral condylar fractures, a technique that circumvents plate contouring.

Translated article] Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate

IntroductionScrew tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methodsA surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46–93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). ResultsThere were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. ConclusionsIn simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.

Estudio biomecánico comparativo de dos configuraciones de tornillos cementados en una fractura simulada de húmero proximal fijada con placa y tornillos bloqueados

IntroductionScrew tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methodsA surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46–93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). ResultsThere were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. ConclusionsIn simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.

Morphometric Study of Supratrochlear Foramen of the Humerus Related with Clinical Implications in a Thai Population

Supratrochlear foramen (STF) is a perforation of bony wall that separates the olecranon fossa and the coronoid fossa. Its incidence varies among different races. The aim of this study was to investigate the prevalence and morphometry of supratrochlear foramen among Thai population. A total of 640 dry humeri from 320 skeletons, 160 paired humeri of each sex, and known age were collected to study the prevalence of STF. The prevalence is reported categorized by sex and the side of humerus to identify whether there is a correlation. STF is categorized by shape and their metrics measured with digital vernier calipers. The ratio of transverse diameter (TD) and distance from the medial epicondyle to the lateral epicondyle (DMLE) were calculated to represent the size of STF. From 640 humeri, 404 cases were translucent septum, 133 cases were opaque septum, and 103 cases were recorded as foramen. In this study, the majority of supratrochlear foramen were oval-shaped, followed by irregular-shaped and round-shaped foramen. The ratio between TD and DMLE was 0.09±0.44 mm on the right and 0.08±0.41 mm on the left which was not significantly different. The findings can be used to understand the variation and location of supratrochlear foramen to help radiologists and orthopedic surgeons to avoid misdiagnosis of cystic lesion at the distal humerus.

Bone histology of Broad-snouted Caiman Caiman latirostris (Crocodylia: Alligatoridae) as tool for morphophysiological inferences in Crocodylia

Bone histology is an important tool for the interpretation of life patterns in animals of the past and extant fauna. The crocodylians have been studied as important inferential models for morphophysiological characteristics. We aimed to characterize the osteohistology of captive Caiman latirostris, identifying its microanatomy related to growth rates, ontogeny, and environmental conditions. We analyzed five pairs of humeri (proximal elements of the appendicular skeleton) and ribs (axial skeleton) of females’ caiman. Ribs showed, in general, woven-fibered tissues, with low vascularization and parallel-fibered bone and many resorption and erosion cavities. It presented lines of arrested growth (LAGs) in three individuals, without skeletochronological compatibility. Humeri showed a gradient of woven-fibered to parallel-fibered and lamellar-zonal bone as the individuals aging. We observed compacted coarse cancellous bone (CCCB) and a higher number of LAGs in older specimens. Ribs remodel faster than humerus, showing an intra-individual histovariability. The humeri indicated an evident growth pattern with different ontogeny stages and growth rates in different ages. Fast-growing tissues are uncommon in crocodylians, but basal metabolism and optimal growth conditions can lead to this. Bone histology of C. latirostris shows patterns that can be used as inferential models for extant and extinct groups, but we encourage further studies for a better understanding, under different environmental conditions, such as temperature and food availability.

Biomechanical comparison of humeral condyles with experimental intracondylar fissures immobilized with a transcondylar positional or a lag screw: An ex-vivo study in dogs.

To compare the axial biomechanical properties of intracondylar humeral osteotomies fixed with 4.5 mm transcondylar positional or cortical lag screws. Ex vivo study. Paired humeri from 21 canine cadavers. An intracondylar osteotomy was created on each humerus to mimic an intracondylar fissure. Paired humeri were randomly assigned to fixation with a positional or a lag screw. All specimens were radiographed postinstrumentation to document proper screw placement. Axial load was applied to the distal articular surface of the trochlea at a rate of 1 mm/s until a 40% decrease in load was measured. Specimens were assessed for mode of failure with visual inspection and radiographs. Stiffness (1236.7 ± 181 N/mm vs. 1050.8 ± 265 N/mm), yield load (3284.3 ± 1703 N vs. 2071.1 ± 740 N), and maximum load (7378.0 ± 1288 vs. 5793.7 ± 2373 N) were greater in constructs fixed with a positional rather than a lag screw (p= .0008, .044, and .040, respectively). In our model, mechanical properties were improved when the transcondylar osteotomy was stabilized with a 4.5 mm positional screw rather than a lag screw. This ex vivo study suggests that a transcondylar lag screw and positional screw are not biomechanically equal. Additional in vivo studies are need to help with clinical decision making when prophylactically treating HIF.

A virtual reality simulator for training the surgical reduction of patient-specific supracondylar humerus fractures

PurposeVirtual reality has been used as a training platform in medicine, allowing the repetition of a situation/scenario as many times as needed and making it patient-specific prior to an operation. Of special interest is the minimally invasive plate osteosynthesis (MIPO). It represents a novel technique for orthopedic trauma surgery, but requires intensive training to acquire the required skills. In this paper, we propose a virtual reality platform for training the surgical reduction of supracondylar fractures of the humerus using MIPO. The system presents a detailed surgical theater where the surgeon has to place the bone fragments properly.MethodsSeven experienced users were selected to perform a surgical reduction using our proposal. Two paired humeri were scanned from a dataset obtained from the Complejo Hospitalario de Jaén. A virtual fracture was performed in one side of the pair, using the other as contralateral part. Users have to simulate a reduction for each case and fill out a survey about usability, using a five-option Likert scale.ResultsThe subjects have obtained excellent scores in both simulations. The users have notably reduced the time employed in the second experiment, being 60% less in average. Subjects have valued the usability (5.0), the intuitiveness (4.6), comfort (4.5), and realism (4.9) in a 1–5 Likert scale. The mean score of the usability survey was 4.66.ConclusionThe system has shown a high learning rate, and it is expected that the trainees will reach an expert level after additional runs. By focusing on the movement of bone fragments, specialists acquire motor skills to avoid the malrotation of MIPO-treated fractures. A future study can fulfill the requirements needed to include this training system into the protocol of real surgeries. Therefore, we expect the system to increase the confidence of the trainees as well as to improve their decision making.

Dynamic locking screws in proximal humeral plate osteosynthesis demonstrate superior fixation properties: a biomechanical study

PurposeAngular stable implants reduced the complication rate in the treatment of humeral head fractures. But the failure rate is still high. To further reduce the risk of cut-out, cement augmentation of screws was introduced. A reason for failure of plate osteosynthesis might be the extremely high stiffness of the screw-plate interface leading to a loss of reduction and cut-out of screws. A more homogeneous distribution of the forces on all screws may avoid secondary dislocation. We hypothesize that dynamic osteosynthesis minimizes screw loosening and results in a higher load to failure than standard locking screws.MethodsTwelve paired human humerus specimens were analysed. A standardized three-part fracture model with a metaphyseal defect was simulated. Within each pair of humeri, one was fixed with a Philos plate and standard locking screws (LS), whereas the other humerus was fixed with a Philos plate and dynamic locking screws (DLS). A cyclic varus-bending test or a rotation test with increasing loading force was performed until failure of the screw-bone-fixation.ResultsIn the varus bending test, pairs failed by screw loosening in the humeral head. The LS-group reached 2901 (601–5201) load cycles until failure, while the DLS-group failed after 3731 (2001–5601) cycles. This corresponds to a median loading of 195 N for the LS-group and 235 N for the DLS-group (p = 0.028). In the rotation test the LS-group reached a median of 1101 (501–1501) load cycles until failure of fixation occurred, while the DLS-group failed after 1401 (401–2201) cycles (p = 0.225).ConclusionsPlate fixation using dynamic locking screws for the treatment of proximal humerus fractures demonstrated more load cycles until failure compared to standard locking plate osteosynthesis.

The upper limb skeleton and behavioral lateralization of modern humans from Zhaoguo Cave, southwestern China.

Aims of the study are to initially describe and comparatively evaluate the morphology of the new Zhaoguo M1 upper limb remains, and contextualize upper limb functional adaptations among those of other worldwide Upper Paleolithic (UP) humans to make inferences about subsistence-related activity patterns in southwestern China at the Pleistocene-Holocene boundary. The preserved Zhaoguo M1 skeletal remains include paired humeri, ulnae, and radii, among others. These specimens were scanned using micro-computed tomography to evaluate internal structural properties, while external osteometric dimensions of the Zhaoguo M1 upper limb elements also were acquired. Both sets of measurements were compared to published data on Neandertals, and Middle and Upper Paleolithic modern humans. The upper limb elements of Zhaoguo M1 display a suite of characteristics that generally resemble those of other contemporary Late UP (LUP) modern humans, while robusticity indices generally fall within the upper range of LUP variation. The Zhaoguo M1 upper limb elements display fewer traits resembling those of late archaic humans. The Zhaoguo M1 individual exhibits diaphyseal asymmetry in several upper limb elements suggesting left hand dominance. When evaluating the full range of magnitudes of humeral bilateral asymmetry in the comparative sample, Zhaoguo M1 falls at the lower end overall, but yet is relatively higher than contemporary LUP modern humans specifically from East Eurasia. The Zhaoguo M1 individual suggests typical LUP modern human upper limb morphology persisted in southwest China until the end of the last glacial period. Upper limb bone asymmetry of Zhaoguo M1 also indicates that behavioral activities attributed to a hunter-gatherer tradition apparently extended through the Pleistocene-Holocene transition in this region.

Reconstruction of proximal humeral fractures with a reduced number of screws and a reinforced bone substitute

Multi-fragmented fractures of the proximal humerus are difficult to treat, especially in the case of osteoporotic bone. Intra-operative risks include cartilage damage when inserting multiple screws. A common post-operative complication is distal-varus collapse of the head. The aim of this study was to investigate if an Innovative technique (reduced number of screws and injection of a beta-TCP additivated partially resorbable cement) provides the same or better stability of the reconstructed head compared to the Standard technique (using more screws). A four-fragment fracture was simulated in six pairs of humeri, with partial removal of the cancellous bone to simulate osteoporotic “eggshell” defect. One humerus of each pair was repaired with a Standard (locking plate, 2 cortical and 6 locking screws), and the other with the Innovative technique (same plate, 2 cortical and only 3 locking screws, plus cement injection). The reconstructed specimens were subjected to a biomechanical test where a cyclic force of increasing amplitude was applied axially until failure. The Innovative reconstructions withstood a force 3.49 times larger than the contralateral Standard reconstructions before failure started. The maximum force before final collapse for the Innovative reconstructions was 4.24 times larger than the contralateral Standard reconstructions. These differences were statistically significant. The Innovative reconstructions, based on fewer screws and beta-TCP additivated acrylic cement, showed positive results, demonstrating better biomechanical properties compared to the Standard reconstructions. These laboratory findings, along with the advantages of a reduced number of screws, may help perform a surgically safer, and more effective procedure in osteoporotic patients.

Evaluation of Threaded External Skeletal Fixation Pin Insertion with and without Predrilling in Avian Bone.

The aim of this study was to document the effects of positive-profile threaded external skeletal fixation (ESF) pin insertion without predrilling on heat generation, structural damage and pullout strength in avian bone than that with predrilling. This study was an ex vivo study. Twenty paired tibiotarsi and 40 paired humeri from 20 Mallard duck cadavers were used. Specimens were randomized to have positive-profile threaded ESF pins placed with or without predrilling insertion sites. Heat generation (maximum-baseline temperature) was measured during drilling and pin insertion with infrared thermography. Structural damage (gross trans-cortical damage and thread quality) was evaluated and scored using a visual analog scale (VAS). Mechanical testing was performed to evaluate pullout strength of inserted pins. VAS scores for trans-cortical surfaces were significantly higher than for cis-cortical surfaces; however, no difference was noted between predrilled and non-predrilled specimens. No significant difference in heat generation or pullout strength was noted between pins placed with and without predrilling. Pin insertion without predrilling in avian humeri and tibiotarsi does not cause significantly more structural damage or heat generation, or reduced pullout strength, compared with predrilling. Overall, our results indicate that predrilling prior to ESF pin placement provides no obvious advantage in avian bone.

Whole bone testing in small animals: systematic characterization of the mechanical properties of different rodent bones available for rat fracture models

ObjectivesRat fracture models are extensively used to characterize normal and pathological bone healing. Despite, systematic research on inter- and intra-individual differences of common rat bones examined is surprisingly not available. Thus, we studied the biomechanical behaviour and radiological characteristics of the humerus, the tibia and the femur of the male Wistar rat—all of which are potentially available in the experimental situation—to identify useful or detrimental biomechanical properties of each bone and to facilitate sample size calculations.Methods40 paired femura, tibiae and humeri of male Wistar rats (10–38 weeks, weight between 240 and 720 g) were analysed by DXA, pQCT scan and three-point-bending. Bearing and loading bars of the biomechanical setup were adapted percentually to the bone’s length. Subgroups of light (skeletal immature) rats under 400 g (N = 11, 22 specimens of each bone) and heavy (mature) rats over 400 g (N = 9, 18 specimens of each bone) were formed and evaluated separately.ResultsRadiologically, neither significant differences between left and right bones, nor a specific side preference was evident. Mean side differences of the BMC were relatively small (1–3% measured by DXA and 2.5–5% by pQCT). Over all, bone mineral content (BMC) assessed by DXA and pQCT (TOT CNT, CORT CNT) showed high correlations between each other (BMC vs. TOT and CORT CNT: R2 = 0.94–0.99). The load–displacement diagram showed a typical, reproducible curve for each type of bone. Tibiae were the longest bones (mean 41.8 ± 4.12 mm) followed by femurs (mean 38.9 ± 4.12 mm) and humeri (mean 29.88 ± 3.33 mm). Failure loads and stiffness ranged from 175.4 ± 45.23 N / 315.6 ± 63.00 N/mm for the femurs, 124.6 ± 41.13 N / 260.5 ± 59.97 N/mm for the humeri to 117.1 ± 33.94 N / 143.8 ± 36.99 N/mm for the tibiae. Smallest interindividual differences were observed in failure loads of the femurs (CV% 8.6) and tibiae (CV% 10.7) of heavy animals, light animals showed good consistency in failure loads of the humeri (CV% 7.7). Most consistent results of both sides (left vs. right) in failure loads were provided by the femurs of light animals (mean difference 4.0 ± 2.8%); concerning stiffness, humeri of heavy animals were most consistent (mean difference of 6.2 ± 5%). In general, the failure loads showed strong correlations to the BMC (R2 = 0.85–0.88) whereas stiffness correlated only moderate, except for the humerus (BMC vs. stiffness: R2 = 0.79).DiscussionAltogether, the rat’s femur of mature specimens showed the most accurate and consistent radiological and biomechanical results. In synopsis with the common experimental use enabling comparison among different studies, this bone offers ideal biomechanical conditions for three point bending experiments. This can be explained by the combination of a superior aspect ratio and a round and long, straight morphology, which satisfies the beam criteria more than other bones tested.

Asymmetry in the Cortical and Trabecular Bone of the Human Humerus During Development.

Many studies have noted that the bones of the human upper limb display bilateral asymmetry, commonly linking this asymmetry in external and internal morphology to handedness and lateralization. Few studies, however, have attempted to track asymmetry throughout ontogeny. This study assesses the ontogenetic development of cortical and trabecular bone asymmetry in the humerus. We predict that directional asymmetry in structural properties will emerge in concert with hand preference and increased activity levels during the juvenile period. Paired humeri from 57 individuals from the Norris Farms #36 archaeological skeletal collection ranging in age from neonate to adult were used in the current study. Cortical bone cross-sectional properties and three-dimensional trabecular bone structure were quantified from microcomputed tomography data. The results indicate significant absolute asymmetry in all measured cortical and trabecular bone variables across all ages. Trabecular bone displays significantly higher absolute asymmetry than cortical bone. Contrary to expectations, however, this study found very little evidence for significant directional asymmetry in humeral length and cortical or trabecular bone variables, except in adults. The presence of significant absolute asymmetry in all age groups, and the lack of significant directional asymmetry in almost all variables at all ages, suggests that structural differences due to higher levels of habitual loading in the dominant arm are overlain on a template of potentially significant existing asymmetry. Anat Rec, 301:1012-1025, 2018. © 2017 Wiley Periodicals, Inc.

A Novel Registration-Based Approach for 3D Assessment of Posttraumatic Distal Humeral Deformities.

With current 3-dimensional (3D) computer-based methods for the assessment of deformities, a surface registration method is applied to superimpose a computer model of the pathological bone onto a mirrored computer model of the contralateral side. However, because of bilateral differences, especially in humeral torsion, such template-based approaches may introduce bias in the assessment of a distal humeral deformity. We hypothesized that a novel registration approach might prove superior to the current approach in reducing such bias, thus yielding improved accuracy of 3D assessment of distal humeral deformities. Three-dimensional triangular surface models were generated from computed tomographic (CT) data of 100 paired humeri without a pathological condition. Humeral segments of varying, predetermined lengths, excluding the distal part of the humerus, were defined. A surface registration algorithm was applied to superimpose the humeral models of both sides based on each selected segment. Humeral contralateral registration (HCR) errors, defined as the residual differences in apparent 3D orientation between the distal parts, were evaluated. The mean HCR error (and standard deviation) using the distal-most humeral shaft segment to assess the angular orientation was 2.3° ± 1.1 (range, 0.5° to 5.8°). Including the humeral head in the surface registration algorithm, however, as is done currently, resulted in a higher HCR error (p < 0.001). The HCR error using the proximal-most segment was >10° in 20% of the cases and between 5° and 10° in an additional 50% of the cases. By comparison, using the proposed distal-most humeral shaft segment, the HCR error was between 5° and 10° in only 2% of cases, and was never >10°. The proximal segments are nevertheless used in the proposed method for registering humeral length. The proposed new approach yields a deformity assessment that is less prone to bias arising from inherent bilateral differences and therefore is more accurate than current surface registration approaches. Accurate 3D assessment is of fundamental importance if computer-based methods are applied in the correction of posttraumatic deformities.

Detection of articular perforations of the proximal humerus fracture using a mobile 3D image intensifier \u2013 a cadaver study

BackgroundThe purpose of this study was to investigate the accuracy of perforation detection with multiplanar reconstructions using a mobile 3D image intensifier.MethodsIn 12 paired human humeri, K-wires perforating the subchondral bone and placed just below the cartilage level were directed toward five specific regions in the humeral head. Image acquisition was initiated by a fluoroscopy scan. Within a range of 90°, 45° external rotation (ER) and 45° internal rotation (IR). The number and percentage of detected perforating screws were grouped and analyzed. Furthermore, the fluoroscopic images were converted into multiplanar CT-like reconstructions. Each K-wire perforation was characterized as “detected” or “not detected”.ResultsIn the series of fluoroscopy images in the standard neutral position at 30° internal rotation, and 30° external rotation, the perforations of all K-wires (n = 56) were detected. Twenty-nine (51.8%) of them were detected in one AP view, 22 (39.3%) in two AP views, and five (8.9%) in three AP views. All K-wire perforations (100%, n = 56) were detected in multiplanar reconstructions.ConclusionIn order to reveal all of the intraoperative and postoperative screw perforations in a “five screw configuration”, conventional AP images should be established in both the neutral positions (0°), at 30° internal rotation and 30° external rotation. Alternatively, the intraoperative 3D scan with multiplanar reconstructions enables a 100% rate of detection of the screw perforations.

Adjunct fixation with a Kirschner wire or a plate for lateral unicondylar humeral fracture stabilization.

To compare the biomechanical properties of using an interfragmentary 1.6 mm Kirschner wire or a 2.7 mm reconstruction plate as adjunctive epicondylar stabilization in simulated comminuted lateral unicondylar humeral fractures stabilized with a transcondylar 4.5 mm cortical screw. Cadaveric biomechanical assessment. Paired humeri harvested from 9 young, skeletally mature dogs. Simulated comminuted lateral unicondylar humeral fractures were stabilized with a transcondylar 4.5 mm cortical screw placed in lag fashion. Adjunct fixations consisting of a 1.6 mm Kirschner wire on one side, and a 2.7 mm reconstruction plate on the contralateral side, were tested within paired humeri. Repaired humeri were axially loaded to failure and construct stiffness, yield load, and load to failure were obtained from the load-deformation curves. Stiffness (mean ± SD: 577 ± 245 vs 310 ± 71 N/mm; P = .01), yield load (mean ± SD: 2389 ± 572 vs 1017 N ± 292; P = .0002), and load at failure (mean ± SD: 3351 ± 358 vs 1693 ± 363 N; P = .009) were greater in constructs incorporating a reconstruction plate rather than a Kirschner wire. Our results support the recommendation for adjunct fixation of comminuted lateral unicondylar humeral fractures with an epicondylar plate.

Computer algorithms for three-dimensional measurement of humeral anatomy: analysis of 140 paired humeri

In the presence of severe osteoarthritis, osteonecrosis, or proximal humeral fracture, the contralateral humerus may serve as a template for the 3-dimensional (3D) preoperative planning of reconstructive surgery. The purpose of this study was to develop algorithms for performing 3D measurements of the humeral anatomy and further to assess side-to-side (bilateral) differences in humeral head retrotorsion, humeral head inclination, humeral length, and humeral head radius and height. The 3D models of 140 paired humeri (70 cadavers) were extracted from computed tomographic data. Geometric characteristics quantifying the humeral anatomy in 3D were determined in a semiautomatic fashion using the developed computer algorithms. The results between the sides were compared for evaluating bilateral differences. The mean bilateral difference of the humeral retrotorsion angle was 6.7° (standard deviation [SD], 5.7°; range, -15.1° to 24.0°; P = .063); the mean side difference of the humeral head inclination angle was 2.3° (SD, 1.8°; range, -5.1° to 8.4°; P = .12). The side difference in humeral length (mean, 2.9 mm; SD, 2.5 mm; range, -8.7 mm to 10.1 mm; P = .04) was significant. The mean side difference in the head sphere radius was 0.5 mm (SD, 0.6 mm; range, -3.2 mm to 2.2 mm; P = .76), and the mean side difference in humeral head height was 0.8 mm (SD, 0.6 mm; range, -2.4 mm to 2.4 mm; P = .44). The contralateral anatomy may serve as a reliable reconstruction template for humeral length, humeral head radius, and humeral head height if it is analyzed with 3D algorithms. In contrast, determining humeral head retrotorsion and humeral head inclination from the contralateral anatomy may be more prone to error.

A virtual geometric morphometric approach to the quantification of long bone bilateral asymmetry and cross-sectional shape.

The widespread use of three-dimensional digitization means that models of whole bone geometry are routinely captured for many applications in virtual anthropology. In this article, we test whether a geometric morphometric (GMM) approach can be used to accurately quantify directional bilateral asymmetry in cross-sectional shape using virtual bone models. We introduce a method to (1) orient virtual long bone models and extract cross sections and (2) collect GMM landmarks to analyze cross-sectional shape. Landmark data, captured using polar radii, were analyzed for an example study set of paired humeri from Andaman Islanders sampled at 35%, 50%, and 65% locations. The GMM method can (1) detect significant differences in left and right cross-sectional shape and (2) allow the directionality of shape change (distribution of bone from centroid) to be evaluated in the context of whole outline shape and in relation to the axis of maximum bending rigidity. The protocol may be used with models created from laser (surface) scan or computed tomography (CT) scan data, and applied to cross-sectional images that were collected using periosteal molding techniques. The results demonstrate directional bilateral asymmetry in shape, but do not recover the same signal for size measurements. Our method offers a pathway to quantify both the pattern of variation in shape and the relationship between size and shape variation, opening new questions about how those patterns manifest over ontogeny, change temporally or differ in relation to the nature and intensity of the activity, and bone loading conditions.

Biomechanical Analysis of Subpectoral Biceps Tenodesis

Background: Humeral fracture after subpectoral tenodesis of the long head of biceps tendon (LHB) is a rare but devastating complication. Purpose: To determine whether malpositioned (laterally eccentric) tenodesis screw placement has an influence on humerus strength reduction compared with central placement. Study Design: Controlled laboratory study. Methods: Two groups, each consisting of 10 matched pairs of human humeri, were used for this study. Biceps tendons were fixed subpectorally with 8-mm screws in unicortical 8-mm sockets. In the first group, the socket was placed concentrically in the bicipital groove and the tendon was fixed with an interference screw. In the second group, the socket was malpositioned 30% eccentrically to the lateral (tension) side of the humerus. Contralateral humeri remained intact as positive controls. Specimens were aligned in 40° of abduction, and a uniaxial compressive force was applied to the humeral head until failure. Strength reduction was reported as percentage reduction in ultimate failure load between paired humeri. Relative defect size was calculated as a percentage of the total humeral width at the height of the tenodesis. Results: Laterally eccentric malpositioned biceps tenodeses significantly decreased humeral strength compared with intact (mean change, −25%; SD, 23%; P = .017), while concentrically placed biceps tenodeses did not (mean change, −10%; SD, 15%; P = .059). A linear regression between relative defect size and strength reduction in the malpositioned group showed a significant negative linear correlation (beta = −2.577; R2 = 0.423; P = .042). Conclusion: Humeral fracture after subpectoral tenodesis of the LHB is a complication that may be minimized with careful surgical technique. Laterally eccentric malpositioned biceps tenodesis caused significant reduction (25%) in humeral strength, which might be clinically relevant and contribute to postsurgical humeral shaft fracture. Strength reduction was also significantly correlated with relative defect size. Surgeons using this technique should ensure central and orthogonal placement of the socket, especially in smaller individuals. This study lends biomechanical evidence to support the clinical procedure of a correctly, concentrically placed tenodesis screw. Clinical Relevance: These biomechanical results indicate that in a clinical setting, special attention should be drawn to patient selection for LHB tenodesis. This study reveals that central screw positioning is critical, particularly in high-impact and overhead athletes, as well as for patients with small humeral widths or osteoporotic bone quality. Alternative surgical options such as smaller screws or other fixation methods might be considered to diminish the postoperative risk of humeral fracture.