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The Journal of Bone and Joint Surgery (American) 84:951-961 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Biomechanical Evaluation of Proximal Humeral Fracture Fixation Supplemented with Calcium Phosphate Cement

Brian K. Kwon, MD, FRCSC, Darrell J. Goertzen, MSc, Peter J. O'Brien, MD, FRCSC, Henry M. Broekhuyse, MD, FRCSC and Thomas R. Oxland, PhD

Investigation performed at the Division of Orthopaedic Engineering Research, Department of Orthopaedics, Vancouver General Hospital, Vancouver, British Columbia, Canada

Brian K. Kwon, MD, FRCSC
Darrell J. Goertzen, MSc
Peter J. O'Brien, MD, FRCSC
Henry M. Broekhuyse, MD, FRCSC
Thomas R. Oxland, PhD
Division of Orthopaedic Trauma (B.K.K., P.J.O'B., and H.M.B.) and Division of Orthopaedic Engineering Research (D.J.G. and T.R.O.), Department of Orthopaedics, University of British Columbia, Vancouver General Hospital, 3415-910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Canadian Orthopaedic Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Proximal humeral fractures are common injuries, and numerous surgical methods have been described for their treatment. The biomechanical characteristics of various internal fixation devices that are used to treat these fractures have not been extensively studied, nor has the potential beneficial effect of calcium phosphate cement supplementation.

Methods: We used a cadaveric three-part proximal humeral osteotomy model to perform a biomechanical evaluation of three types of internal fixation devices: a cloverleaf plate, an angled blade-plate, and Kirschner wires. The effect of supplementing the fixation with SRS (Skeletal Repair System) calcium phosphate cement was evaluated as well. Eighteen pairs of fresh-frozen humeri were obtained, and the bone-mineral density of each specimen was measured. In each pair, one specimen was secured with internal fixation alone and the contralateral specimen was secured with internal fixation combined with calcium phosphate cement. The specimens were tested cyclically in abduction and in external rotation for 250 cycles to evaluate interfragmentary motion. The specimens were then loaded to failure in external rotation to measure torsional load to failure and torsional stiffness.

Results: Overall, there were no significant differences between the specimens treated with the blade and cloverleaf plates, whereas the specimens treated with Kirschner wires demonstrated more interfragmentary motion, less stiffness, and lower torque to failure. In general, supplementation with calcium phosphate cement led to significant improvements in the mechanical performance of all three forms of internal fixation as demonstrated by a significant decrease in interfragmentary motion, a significant increase in torque to failure, and a significant increase in torsional stiffness. The addition of calcium phosphate cement increased the stiffness of even the most osteoporotic specimens to levels that were higher than those of the most osteodense specimens that had been treated with internal fixation alone.

Conclusion: The initial biomechanical properties of internal fixation as measured with use of a proximal humeral osteotomy model and three methods of fixation were significantly improved by the addition of calcium phosphate cement.

Clinical Relevance: The addition of calcium phosphate cement may augment the mechanical characteristics of internal fixation of difficult, three-part proximal humeral fractures. The ability to stabilize the interface between the implant and cancellous bone, particularly in the presence of osteopenia, may make calcium phosphate cement a valuable clinical tool in the treatment of these difficult fractures.


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