Mechanical Quantification of Local Bone Quality in the Humeral Head: A Feasibility Study
Alexander Scola 1, Florian Gebhard 1, Sebastian Weckbach 1, Christoph Dehner 1, Ronald Schwyn 2, Ladina Fliri 2, Götz Röderer*, 1
1 Department of Orthopaedic Trauma, Ulm University, Ulm, Germany
2 AO Research Institute, Davos, Switzerland
Surgical treatment of proximal humerus fractures can be challenging due to osteoporosis. The weak bone stock makes stable implant anchorage difficult, which can result in low primary stability. Accordingly, significant failure rates, even with modern locking plates, are reported in the literature. Intraoperative knowledge of local bone quality could be helpful in improving results. This study evaluates the feasibility of local bone quality quantification using breakaway torque measurements.
Materials and Methods:
A torque measurement tool (DensiProbe™) was developed to determine local resistance to breakaway offered by the cancellous bone in the humeral head to quantify local bone quality. The tool was adapted to a standard locking plate (PHILOS, Synthes), allowing measurement in the positions of the six humeral head screws, as provided by the aiming device of the plate. Two hundred and seventy measurements were performed in 44 fresh cadaveric human humeri.
Handling of the tool was straight forward and provided reproducible results for the six different positions. The method allows discrimination between the respective positions with statistical significance, and thus provides reliable information on the local distribution of bone quality within the humeral head.
This study introduces a new method using breakaway torque to determine local bone quality within the humeral head in real time. Because DensiProbe is adapted to a standard locking plate, there is the potential for intraoperative application. The information provided could enable the surgeon to improve fixation of osteoporotic proximal humerus fractures.
Keywords: Bone quality, DensiProbe, fracture, osteoporosis, proximal humerus.
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.
* Address correspondence to this author at the Department of Orthopaedic Trauma, Ulm University, Albert-Einstein-Allee 23, D-89081 Ulm, Germany; Tel: +49 731 50054565; Fax: +49 731 50054502;