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Additive fiber-cerclages in proximal humeral fractures stabilized by locking plates: no effect on fracture stabilization and rotator cuff function in human shoulder specimens.

Voigt C, Hurschler C, Rechi L, Vosshenrich R, Lill H - Acta Orthop (2009)

Bottom Line: The capacity of the rotator cuff to strain was analyzed with an optical system.Cerclages did not impair the capacity of the rotator cuff to strain.INTERPRETATION; Provided that unstable 3-part fractures are reduced and stabilized anatomically by a locking plate, additive fiber-cerclages do not reduce interfragmentary motion.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift gGmbH, Hannover, Germany. christine.voigt@friederikenstift.de

ABSTRACT

Background and purpose: The effect of additive fiber-cerclages in proximal humeral fractures stabilized by locking plates on fracture stabilization and rotator cuff function is unclear. Here it was assessed in a human cadaver study.

Methods: 24 paired human shoulder specimens were harvested from median 77-year-old (range 66-85) female donors. An unstable 3-part fracture model with an intact rotator cuff was developed. 1 specimen of each pair received an additive fiber-cerclage of the rotator cuff after plate fixation, and the other one received a plate fixation without an additive fiber-cerclage. Force-controlled hydraulic cylinders were used to simulate physiological rotator cuff tension, while a robot-assisted shoulder simulator performed 4 relevant cases of load: (1) axial loading at 0 degrees, (2) glenohumeral abduction at 60 degrees, (3) internal rotation at 0 degrees abduction, and (4) external rotation at 0 degrees abduction, and imitated hanging arm weight during loading without affecting joint kinematics. A 3-dimensional real-time interfragmentary motion analysis was done in fracture gaps between the greater tuberosity and the head, as well as subcapital. The capacity of the rotator cuff to strain was analyzed with an optical system.

Results: Interfragmentary motion was similar between the groups with and without fiber-cerclages, in both fracture gaps and in any of the cases of load. Cerclages did not impair the capacity of the rotator cuff to strain. INTERPRETATION; Provided that unstable 3-part fractures are reduced and stabilized anatomically by a locking plate, additive fiber-cerclages do not reduce interfragmentary motion. Additive fiber-cerclages may be necessary in locking plate osteosyntheses of multiple-fractured greater tuberosities or lesser tuberosity fractures that cannot be fixed sufficiently by the plate.

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A. Unstable 3-part fracture model with fiber-cerclages of the proximal humerus intact rotator cuff. Fracture gap I (à) and II (- ->). Three point-pairs (….>) for measurement of rotator cuff strain. B. AP and C. axillary views of an unstable 3-part-fracture model.
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Figure 0002: A. Unstable 3-part fracture model with fiber-cerclages of the proximal humerus intact rotator cuff. Fracture gap I (à) and II (- ->). Three point-pairs (….>) for measurement of rotator cuff strain. B. AP and C. axillary views of an unstable 3-part-fracture model.

Mentions: All left shoulders of the pairs received a standardized additive fiber-cerclage of SSC, SSP, and ISP+TM (Figure 2a). Thus, 3 non-absorbable Fiber-wire size 2 (Arthrex) were pre-placed in specially designed plate holes. The SSC was attached by a 2-cm wide u-shaped stitch 4 cm away from the ventral edge of the plate, SSP, and ISP+TM by diverging 2-cm wide u-shaped stitches 2 cm away from the cranial and dorsal edges, respectively. Sutures were knotted and the metal blades in gap I excluded. All specimens were examined radiographically after preparation to control and document correct implant and gap positioning (Figure 2b).


Additive fiber-cerclages in proximal humeral fractures stabilized by locking plates: no effect on fracture stabilization and rotator cuff function in human shoulder specimens.

Voigt C, Hurschler C, Rechi L, Vosshenrich R, Lill H - Acta Orthop (2009)

A. Unstable 3-part fracture model with fiber-cerclages of the proximal humerus intact rotator cuff. Fracture gap I (à) and II (- ->). Three point-pairs (….>) for measurement of rotator cuff strain. B. AP and C. axillary views of an unstable 3-part-fracture model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823188&req=5

Figure 0002: A. Unstable 3-part fracture model with fiber-cerclages of the proximal humerus intact rotator cuff. Fracture gap I (à) and II (- ->). Three point-pairs (….>) for measurement of rotator cuff strain. B. AP and C. axillary views of an unstable 3-part-fracture model.
Mentions: All left shoulders of the pairs received a standardized additive fiber-cerclage of SSC, SSP, and ISP+TM (Figure 2a). Thus, 3 non-absorbable Fiber-wire size 2 (Arthrex) were pre-placed in specially designed plate holes. The SSC was attached by a 2-cm wide u-shaped stitch 4 cm away from the ventral edge of the plate, SSP, and ISP+TM by diverging 2-cm wide u-shaped stitches 2 cm away from the cranial and dorsal edges, respectively. Sutures were knotted and the metal blades in gap I excluded. All specimens were examined radiographically after preparation to control and document correct implant and gap positioning (Figure 2b).

Bottom Line: The capacity of the rotator cuff to strain was analyzed with an optical system.Cerclages did not impair the capacity of the rotator cuff to strain.INTERPRETATION; Provided that unstable 3-part fractures are reduced and stabilized anatomically by a locking plate, additive fiber-cerclages do not reduce interfragmentary motion.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift gGmbH, Hannover, Germany. christine.voigt@friederikenstift.de

ABSTRACT

Background and purpose: The effect of additive fiber-cerclages in proximal humeral fractures stabilized by locking plates on fracture stabilization and rotator cuff function is unclear. Here it was assessed in a human cadaver study.

Methods: 24 paired human shoulder specimens were harvested from median 77-year-old (range 66-85) female donors. An unstable 3-part fracture model with an intact rotator cuff was developed. 1 specimen of each pair received an additive fiber-cerclage of the rotator cuff after plate fixation, and the other one received a plate fixation without an additive fiber-cerclage. Force-controlled hydraulic cylinders were used to simulate physiological rotator cuff tension, while a robot-assisted shoulder simulator performed 4 relevant cases of load: (1) axial loading at 0 degrees, (2) glenohumeral abduction at 60 degrees, (3) internal rotation at 0 degrees abduction, and (4) external rotation at 0 degrees abduction, and imitated hanging arm weight during loading without affecting joint kinematics. A 3-dimensional real-time interfragmentary motion analysis was done in fracture gaps between the greater tuberosity and the head, as well as subcapital. The capacity of the rotator cuff to strain was analyzed with an optical system.

Results: Interfragmentary motion was similar between the groups with and without fiber-cerclages, in both fracture gaps and in any of the cases of load. Cerclages did not impair the capacity of the rotator cuff to strain. INTERPRETATION; Provided that unstable 3-part fractures are reduced and stabilized anatomically by a locking plate, additive fiber-cerclages do not reduce interfragmentary motion. Additive fiber-cerclages may be necessary in locking plate osteosyntheses of multiple-fractured greater tuberosities or lesser tuberosity fractures that cannot be fixed sufficiently by the plate.

Show MeSH
Related in: MedlinePlus