Das DHS-Prinzip in der Versorgung proximaler Humerusfrakturen

BACKGROUND: Despite the use of angular stable implants for proximal humeral fractures a lot of problems remain unsolved such as cutting out of screws, secondary displacement of the greater tubercle and the aim to minimize operative morbidity. This study analyses whether a plate using the DHS principle (H-DHS plate) may overcome these shortcomings. METHODS: In Phase A 8 intact enbalmed human cadaver shoulders received plate fixation in a minimally invasive technique. Humeri were then dissected by an independent examiner and the course of the axillary and radial nerve in relation to the implant were displayed. In Phase B a Neer IV/3 fracture was created with a 5 mm osteotomy gap simulating metaphyseal comminution. Limbs were randomly assigned to receive H-DHS plate fixation and on the contralateral limb Philos plate fixation before biomechanical evaluation (MTS-Bionix 858.2). FINDINGS: Submuscular positioning of the plate did not cause any damage to the axillary nerve, joint capsule or rotator cuff. With a mean stiffness of 300.9 +/- 28.8N/mm the H-DHS plate proved to be significantly stiffer than the Philos plate (184.2 +/- 23.4 N/mm; p=0.006). The H-DHS plate also resisted higher loads in terms of fixation failure with loss of reduction at 290 +/- 58.6N in comparison to 205 +/-8.6N for the Philos plate (p=0.2). Displacement of the greater tubercle occured in no case of the H-DHS group and in two out of four cases in the Philos group. INTERPRETATION: The H-DHS plate can be savely inserted in a minimally invasive technique and provides a high fixation stability in an in vitro humeral head fracture model.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2009

Author dc:creator

• Gradl, Gertraud

Contributors dc:contributor

• Pape, Hans-Christoph

• info:eu-repo/classification/ddc/610
• Biomechanik
• Oberarmbruch
• Osteosynthese
• Anatomie
• Medizin
• proximale Humerusfraktur
• humeral head fracture
• plate
• osteosynthesis
• DHS
• biomechanical testing
• angular stability

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-113710%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A51418