Biomechanical evaluation of cable and suture cerclages for tuberosity reattachment in a 4-part proximal humeral fracture model treated with reverse shoulder arthroplasty

Journal of Shoulder and Elbow Surgery
Dominik KnierzingerWerner Schmoelz

Abstract

Sufficient tuberosity fixation in proximal humeral fractures treated with shoulder arthroplasty is essential to gain a good clinical outcome. This biomechanical study evaluated the strength of the reattached tuberosities in reverse total shoulder arthroplasty fixed with cables or with sutures in a cerclage-like technique. Considering the mechanical advantages of flexible titanium alloy cables compared with conventional sutures for cerclage-like fixations, we hypothesized that titanium alloy cables would achieve higher fixation strengths of the tuberosities compared with heavy nonabsorbable sutures. A 4-part fracture was created on 8-paired proximal human humeri. The tuberosities were reduced anatomically and fixed by 2 heavy nonabsorbable sutures (suture group) or by two 1-mm titanium alloy cables (cable group) in a cerclage-like technique around the neck of the prosthesis. The humeri were placed in a custom-made test setup enabling internal and external rotation. Cyclic loading with a stepwise increasing load magnitude was applied with a material testing machine, starting with 1 Nm and increasing the load by 0.25 Nm after each 100th cycle until failure of the fixation occurred (>15° rotation of the tuberosities). Any motion of...Continue Reading

Citations

Dec 4, 2019·Journal of Orthopaedic Surgery·Suriya LuenamArkaphat Kosiyatrakul
Mar 21, 2020·The Journal of the American Academy of Orthopaedic Surgeons·Brandon J EricksonReuben Gobezie
Oct 4, 2020·Journal of Shoulder and Elbow Surgery·Jonas SchmalzlLars-Johannes Lehmann
Mar 9, 2021·JSES International·Florian GrubhoferSamy Bouaicha
Mar 10, 2019·The Orthopedic Clinics of North America·Michael A Stone, Surena Namdari
Sep 19, 2020·The Journal of the American Academy of Orthopaedic Surgeons·Patrick J DenardLaurence D Higgins
May 23, 2021·Journal of Shoulder and Elbow Surgery·J Christoph KatthagenBenedikt Schliemann

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