Biomechanical Behavior of Composite Bone-Osteosynthesis Constructs in Complex Proximal Humerus Fractures: A Synergistic Experimental and Finite Element Approach.

This study evaluates the mechanical behavior of bone-implant assemblies used in treating complex proximal humerus fractures, a clinical challenge due to the anisotropic nature of bone and variability in patient-specific conditions. The aim of this study was to compare the stability and stress distribution of three fixation methods: polyaxial locking plates, monoaxial locking plates, and intramedullary nails. Using 4th-generation composite humerus models, a four-part fracture (Neer IV) was simulated. The assemblies underwent axial compression testing using a universal testing machine, complemented by finite element analysis (FEA) and stereomicroscopy. The results indicate that while both plate types exhibited similar mechanical behavior-with stiffness values around 113-115 N/mm and failure initiated by plastic deformation of the implant-the intramedullary nail configuration demonstrated higher stiffness values under the tested experimental conditions (1084 N/mm), approximately 9.5 times higher than that of the plates. However, the nail assembly failed through brittle fracture of the bone rather than implant deformation. We conclude that while the intramedullary nail configuration demonstrated higher stiffness under the tested experimental conditions, its performance is heavily dependent on bone quality. In contrast, locking plates may provide a more gradual load-transfer behavior by transferring a greater proportion of the mechanical load to the implant, potentially making them more suitable for osteoporotic bone conditions, where reducing excessive stress concentration within the bone tissue may be beneficial.