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Evaluation of significant effects on locking plates design for a 2-part fracture of the surgical neck of the humerus using finite element and statistical analysis

Ismael Mendoza-Munoz, Alvaro Gonzalez-Angeles, Margarita Gil-Samaniego-Ramos, Roberto L-Avitia, Ciceron Gonzalez-Toxqui

Surgical options for proximal humeral fractures continue with complications in elderly patients with avascular necrosis, screw cut-out and re-operation rate. The literature suggests that these problems on the fracture fixation could be related to the implant stiffness. The main factors involved in this scenario include the physiological loading conditions, the support screws configuration, the implant material and the bone quality. The goal of this study was to determine the effects of the mentioned factors in order to establish a favourable scenario to avoid the fracture fixation failure. The finite element method in association with a two-level 24 full-factorial design model and its statistical products were used to develop this research. Results suggest that the implant material is the factor with the most relevant effect to provide stiffness on the fracture fixation, following by the support configuration. The use of a medial support with calcar screws on different qualities of bone tissue offers an optimal level of rigidity than those who do not use them. A beneficial scenario is obtained by medial support with calcar screws for the implant fixation on a 2-part surgical neck fracture of the proximal part of the humerus model.