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Joint Diseases and
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Original Article · Open access

Biomechanical comparison of three fixation methods under axial loading in proximal humerus fractures with medial metaphyseal defect

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Muhlik Akyürek

Department of Orthopedics and Traumatology, Maria-josef Hospital, Greven, Germany

ORCID: 0000-0002-4907-8840

Emre Koraman

Department of Orthopedics and Traumatology, Pendik Bölge Hospital, İstanbul, Türkiye

ORCID: 0000-0003-2715-2875

Aykut Çelik

Department of Orthopedics and Traumatology, Beykoz State Hospital, İstanbul, Türkiye

ORCID: 0000-0002-5910-0829

Yusuf Iyetin

Department of Orthopedics and Traumatology, Pendik Bölge Hospital, İstanbul, Türkiye

ORCID: 0000-0001-5530-7729

Clemens Kösters

Department of Orthopedics and Traumatology, Maria-josef Hospital, Greven, Germany

ORCID: 0000-0002-9150-7282

Ismail Türkmen

Department of Orthopedics and Traumatology, Klinikum Osnabrück GmbH Center of Musculoskeletal Surgery, Osnabrück, Germany

ORCID: 0000-0001-7594-1989

Abstract

Objectives: This study aims to compare the biomechanical performance of three different surgical fixation techniques in the treatment of proximal humerus fractures with medial metaphyseal defects.

Materials and methods: A total of 24 synthetic humerus bone models were used and equally divided into three groups (n = 8 per group). A standardized unstable proximal humerus fracture model with a medial metaphyseal cortical defect extending to the surgical neck was created using a three-dimensional (3D)-printed osteotomy guide. Group 1 received fixation with a lateral anatomical locking plate. Group 2 was treated with a combination of a lateral anatomical plate and a medial buttress plate (dual plating). Group 3 underwent fixation with an intramedullary nail (IMN); in this group, four specimens had distal locking with an endopin (Group 3a), and the other four with static screws (Group 3b). All specimens were subjected to axial loading until failure. Forces at the onset of failure and complete failure were recorded, and fracture patterns were documented.

Results: In Groups 1 and 2, transverse fractures consistently occurred at the level of the most distal screw of the lateral plate. In Group 3, failure was observed either proximally or distally at the nail tip, including butterfly fragment formation and metaphyseal collapse. Group 2 exhibited the highest resistance to axial loading, followed by Group 1 and Group 3, with statistically significant differences between all groups (p = 0.043, p = 0.0003, p < 0.00001). No significant difference was found between subgroups 3a and 3b (p > 0.05).

Conclusion: Our study results indicate that double plating provides the greatest axial stability in proximal humerus fractures with medial metaphyseal defects, supporting its use in fracture patterns with medial column deficiency. However, as fixation choice should be guided by patient-specific factors and surgical feasibility, these findings should be interpreted in the context of experimental conditions and loading limitations.

Declarations

Author Contributions

M.A.: Idea/concept, design, writing the article, other (performed surgical procedures); E.K.: Data collection and processing, analysis, writing the article; A.Ç.: Other (performed surgical procedures), data collection, references; Y.I.: Design, literature review; C.K.: Critical review, control/supervision; I.T.: Materials, idea/ concept, control/supervision.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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