ArticleBone & joint research2020
Cement augmentation of calcar screws may provide the greatest reduction in predicted screw cut-out risk for proximal humerus plating based on validated parametric computational modelling: Augmenting proximal humerus fracture plating.
Article in Bone & joint research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 22 citations in OpenAlex.
- Biomechanical and clinical comparison of a novel dual-wing locking plate versus the PHILOS plate for neer three- and four-part proximal humeral fractures: a finite element analysis combined with a retrospective cohort study.Frontiers in bioengineering and biotechnology · 2026Article
- Assessing the Influence of Screw Orientation on Fracture Fixation of the Proximal Humerus Using Finite Element Informed Surrogate Modeling.International journal for numerical methods in biomedical engineering · 2025Article
- Biomechanical study of two different fixation methods for the treatment of Neer III proximal humerus fractures.BMC musculoskeletal disorders · 2024Article
- Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study.Life (Basel, Switzerland) · 2023Article
- Plate Fixation of Proximal Humerus Fractures: How to Get It Right and Future Directions for Improvement.Current reviews in musculoskeletal medicine · 2023Review
- Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes.Journal of clinical medicine · 2023Article
- A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients.Medicina (Kaunas, Lithuania) · 2022Article
- [Augmentation in the treatment of proximal humeral and femoral fractures].Unfallchirurgie (Heidelberg, Germany) · 2022Review
- [Cement augmentation and bone graft substitutes-Materials and biomechanics].Unfallchirurgie (Heidelberg, Germany) · 2022Review
- Locking Plates With Computationally Enhanced Screw Trajectories Provide Superior Biomechanical Fixation Stability of Complex Proximal Humerus Fractures.Frontiers in bioengineering and biotechnology · 2022Article
- The effect of cement augmentation on pedicle screw fixation under various load cases : results from a combined experimental, micro-CT, and micro-finite element analysis.Bone & joint research · 2021Article
- Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients.JSES international · 2021Article
- Finite Element Analysis of Fracture Fixation.Current osteoporosis reports · 2021Review
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsFixation of osteoporotic proximal humerus fractures remains challenging even with state-of-the-art locking plates. Despite the demonstrated biomechanical benefit of screw tip augmentation with bone cement, the clinical findings have remained unclear, potentially as the optimal augmentation combinations are unknown. The aim of this study was to systematically evaluate the biomechanical benefits of the augmentation options in a humeral locking plate using finite element analysis (FEA).
methodsA total of 64 cement augmentation configurations were analyzed using six screws of a locking plate to virtually fix unstable three-part fractures in 24 low-density proximal humerus models under three physiological loading cases (4,608 simulations). The biomechanical benefit of augmentation was evaluated through an established FEA methodology using the average peri-screw bone strain as a validated predictor of cyclic cut-out failure.
resultsThe biomechanical benefit was already significant with a single cemented screw and increased with the number of augmented screws, but the configuration was highly influential. The best two-screw (mean 23%, SD 3% reduction) and the worst four-screw (mean 22%, SD 5%) combinations performed similarly. The largest benefits were achieved with augmenting screws purchasing into the calcar and having posteriorly located tips. Local bone mineral density was not directly related to the improvement.
conclusionThe number and configuration of cemented screws strongly determined how augmentation can alleviate the predicted risk of cut-out failure. Screws purchasing in the calcar and posterior humeral head regions may be prioritized. Although requiring clinical corroborations, these findings may explain the controversial results of previous clinical studies not controlling the choices of screw augmentation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.