Lateral Wall Integrity of the Greater Tuberosity Is Important for the Stability of Osteoporotic Proximal Humeral Fractures After Plate Fixation

Abstract

Background: Previous studies assessing surgical fixation of osteoporotic proximal humeral fractures have primarily focused on medial calcar support. In this study, we utilized a specific model for 2-part surgical neck fracture of the osteoporotic proximal humerus to investigate how severe comminution of the greater tuberosity (GT) lateral wall affects biomechanical stability after fixation with a plate. Methods: Ten matched pairs of cadaveric humeri (right and left) were assigned to either a surgical neck fracture alone (the SN group) or a surgical neck fracture with GT lateral wall comminution (the LW group) with use of block randomization. We removed 5 mm of the lateral wall of the GT to simulate severe comminution of the lateral wall. Axial compression stiffness, torsional stiffness, varus bending stiffness, and the single load to failure in varus bending were measured for all plate-bone constructs. Results: Compared with the SN group, the LW group showed a significant decrease in all measures, including torsional stiffness (internal, p = 0.007; external, p = 0.007), axial compression stiffness (p = 0.002), and varus bending stiffness (p = 0.007). In addition, the mean single load to failure in varus bending for the LW group was 62% lower than that for the SN group (p = 0.005). Conclusions: Severe comminution of the GT lateral wall significantly compromised the biomechanical stability of osteoporotic, comminuted humeral surgical neck fractures. Clinical Relevance: Although the generalizability of this cadaveric model may be limited to the extreme clinical scenario, the model showed that severe comminution of the GT lateral wall significantly compromised the stability of osteoporotic humeral surgical neck fractures fixed with a plate and screws alone.