Refixation stability in shoulder hemiarthroplasty in case of four-part proximal humeral fracture |
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Authors: | Daniel Baumgartner Silvio René Lorenzetti Robert Mathys Beat Gasser and Edgar Stüssi |
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Institution: | (1) ETH Zürich, Institute for Biomechanics, HCI E 451, Wolfgang Pauli Strasse 10, 8093 Zurich, Switzerland;(2) RMS Foundation, Bischmattstrasse 12, 2544 Bettlach, Switzerland |
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Abstract: | Primary stability of refixated fractures in case of shoulder hemiarthroplasty is a prerequisite to restore physiological glenohumeral
joint function. Clinical observations often show a secondary dislocation and subsequent resorption of the bony anchor points
like the greater and lesser tuberosity at the rotator cuff tendons. This failed integration leads to impaired glenohumeral
load transmission and subsequent reduction of mobility. As a consequence, the optimisation of refixation methods is crucial
for a better clinical outcome. To prove the stability of refixation techniques, a Finite Element fracture model was built.
Resulting stresses at the bone surface and fragment migration relative to the prosthesis shaft were studied. The results of
the calculations show that the isolated tuberosities show unstressed bone regions compared to the intact model. This circumstance
may explain the clinically detected bone resorption due to the absence of mechanical stimuli. Furthermore, a cable guidance
through lateral holes in the middle part of the proximal prosthesis results in a lower fragment displacement than a circumferential
fixation method surrounding the entire proximal bone. |
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Keywords: | Shoulder prosthesis Hemiarthroplasty Proximal humeral fracture Tuberosity fixation Cerclage technique |
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