Lee Cheng-Hung, Hung Li-Kun, Yen Yu-Chun, Su Kuo-Chih
Department of Orthopedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402, Taiwan.
Sci Rep. 2025 Aug 9;15(1):29211. doi: 10.1038/s41598-025-09848-5.
A humeral locking plate augmented with fibular strut allograft treated for proximal humeral fracture without internal structural support is satisfactory. While it is better clinically and biomechanically than the locking plate alone, it has disadvantages, including difficulty to obtain and the possibility of infection. Other alternative augmentation approaches are in demand. Therefore, the hypothesis of this study is whether intramedullary strut plate can replace fibular strut allograft as a surgical method while providing similar biomechanical performance. The finite element analysis (FEA) models were established based on three-dimensional computed tomography images. Computer-aided design implants were incorporated into the models. According to different implants, models were divided into four groups: the intact humerus, humeral locking plate alone (LP), humeral locking plate augmented with fibular strut allograft (FA), and humeral locking plate augmented with intramedullary strut plate (IMP). The displacements and von Mises stresses were measured on the models by simulating axial force, oblique force and torsion. Compared with the LP group, the displacements and von Mises stresses on the humerus and humeral locking plate in the FA, and IMP groups were all smaller in axial force, oblique force, and torsion. The biomechanical effects of FA and IMP in proximal humeral fracture without internal structural support were basically similar in terms of axial force, oblique force, and torsion. Findings provide useful new ideas for implant design. Our FEA simulation indicates that both the fibular strut allograft (FA) and intramedullary strut plate (IMP) offer similar biomechanical stability in treating proximal humeral fractures without internal structural support. This supports the hypothesis that the intramedullary strut plate can effectively replace the fibular strut allograft.
采用带腓骨支撑异体骨增强的肱骨锁定钢板治疗无内部结构支撑的肱骨近端骨折，效果令人满意。虽然它在临床和生物力学方面比单独的锁定钢板更好，但也有缺点，包括获取困难和感染的可能性。需要其他替代的增强方法。因此，本研究的假设是髓内支撑钢板能否在提供相似生物力学性能的同时，作为一种手术方法替代腓骨支撑异体骨。基于三维计算机断层扫描图像建立了有限元分析（FEA）模型。将计算机辅助设计的植入物纳入模型。根据不同的植入物，模型分为四组：完整肱骨组、单独的肱骨锁定钢板组（LP）、带腓骨支撑异体骨增强的肱骨锁定钢板组（FA）和带髓内支撑钢板增强的肱骨锁定钢板组（IMP）。通过模拟轴向力、斜向力和扭转力，测量模型上的位移和冯·米塞斯应力。与LP组相比，FA组和IMP组在轴向力、斜向力和扭转力作用下，肱骨和肱骨锁定钢板上的位移和冯·米塞斯应力均较小。在轴向力、斜向力和扭转力方面，FA和IMP在治疗无内部结构支撑的肱骨近端骨折中的生物力学效果基本相似。研究结果为植入物设计提供了有用的新思路。我们的有限元分析模拟表明，腓骨支撑异体骨（FA）和髓内支撑钢板（IMP）在治疗无内部结构支撑的肱骨近端骨折时都提供了相似的生物力学稳定性。这支持了髓内支撑钢板可以有效替代腓骨支撑异体骨的假设。
