Biomechanical analysis of blade plate versus locking plate fixation for a proximal humerus fracture: Comparison using cadaveric and synthetic humeri

Objective: To compare the mechanical stability of a fixed-angle blade plate with that of a locking plate in a cadaveric proximal humerus fracture-fixation model subjected to cyclic loading. A secondary objective was to evaluate whether the use of synthetic humerus specimens would replicate significant differences found during cadaveric tests. Design: Mechanical evaluation of constructs in bending and torsion. Setting: Biomechanical laboratory in an academic medical center. Methods: Simulated humeral neck fractures (Orthopaedic Trauma Association (OTA) classification 11A3), in matched-pair cadaveric and synthetic specimens underwent fixation using either a 3.5-mm, 90-degree cannulated LC-Angled Blade Plate or a 3.5-mm LCP Proximal Humerus Locking Plate. Cadaveric specimen constructs were cyclically loaded in bending and torsion; synthetic specimens were tested in torsion. Main Outcome Measure: Humeral shaft-bending displacements and angular rotations for respective cyclic bending loads and axial torques were recorded and compared at repeated cyclic intervals to evaluate construct loosening. Results: Locking-plate constructs exhibited significantly less loosening than blade-plate constructs for torsional loading in cadaveric specimens (P = 0.036). The two types of constructs performed similarly for torsional loading in synthetic specimens (P = 0.100). Under cyclic. closed-bending load conditions in which the plates served as tension members, both types of constructs performed similarly in cadaveric specimens (P = 0.079). Conclusions: For simulated humeral neck fractures subjected to cyclic loading. locking-plate constructs demonstrated significantly greater torsional stability and similar bending stability to blade plates in a cadaveric specimen model. In contrast, these same constructs performed similarly with torsional loading when using synthetic humerus specimens. These results indicate potential advantages for locking-plate fixation. They also indicate that the synthetic specimens tested may not be appropriate for evaluating fixation stability in the humeral head, where cancellous bone fixation predominates.