{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:32:38Z","timestamp":1781782358349,"version":"3.54.5"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008001","name":"Universit\u00e4t zu K\u00f6ln","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008001","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Complex proximal humeral fracture ranks among the most common fracture types, especially in elderly patients. In locked plate fixation of proximal humerus fractures, the calcar is deciding for screws providing further medial column support. To date, the biomechanical effect of the length of these calcar screws is not well known. The purpose of this study was to analyze the effect of long calcar screws on fresh frozen prefractured cadaveric specimens.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In the present biomechanical study, 8 pairs of cadaveric proximal humeri were fractured identically using a custom-made fracture simulator. ORIF was performed using a locking plate (PHILOS; Fa. Synthes). The specimens were tested in a biomechanical setup under increased axial load without any calcar screws installed, with short calcar screws and long calcar screws installed. Strain gages (4-wire-120 Ohm, Fa. Vishay) mounted on the locking plate were used to evaluate the fixation strain and to give an estimate for primary stability..<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The measured strain of the locking plate without calcar screws (804,64\u00a0\u00b5m\/m) at maximum load (200\u00a0N) was significantly higher than with short (619,07\u00a0\u00b5m\/m; <jats:italic>p<\/jats:italic>\u2009=\u20090.02) or long calcar screws (527,31\u00a0\u00b5m\/m; <jats:italic>p<\/jats:italic>\u2009=\u20090.007). Additionally, strain with short calcar screws was noticeably higher in comparison to long calcar screws (619,07\u00a0\u00b5m\/m vs. 527,31\u00a0\u00b5m\/m; <jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Use of calcar screws improves the stability of realistically impacted 3-part varus humeral fractures. Long calcar screws that are positioned as close as possible to the joint provide further primary stability compared to short calcar screws.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Basic science study.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-022-04473-7","type":"journal-article","created":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T06:02:32Z","timestamp":1653890552000},"page":"2485-2491","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The effect of long calcar screws on the primary stability of 3-part, varus impacted proximal humeral fractures compared to short calcar screws: a real fracture simulation study"],"prefix":"10.1007","volume":"143","author":[{"given":"Nadine","family":"Ott","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6183-5621","authenticated-orcid":false,"given":"Michael","family":"Hackl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Prescher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Scaal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Lanzerath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Peter","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kilian","family":"Wegmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"issue":"4","key":"4473_CR1","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/000164701753542023","volume":"72","author":"CM Court-Brown","year":"2001","unstructured":"Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365\u2013371. https:\/\/doi.org\/10.1080\/000164701753542023","journal-title":"Acta Orthop Scand"},{"key":"4473_CR2","doi-asserted-by":"crossref","unstructured":"Einsiedel T, Becker C, Stengel D, Schmelz A (2006):Frakturen der oberen Extremit\u00e4t beim geriatrischen Patienten - Harmlose Monoverletzung oder Ende der Selbst\u00e4ndigkeit? Eine prospektive Studie zum Outcome nach distaler Radius- und proximaler Humerusfraktur bei \u00fcber 65-j\u00e4hrigen. Zeitschrift f\u00fcr Gerontologie + Geriatrie mit Eur J Geriatr 39 (6):451\u201361","DOI":"10.1007\/s00391-006-0378-2"},{"key":"4473_CR3","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1007\/s00402-002-0465-94","volume":"123","author":"H Lill","year":"2003","unstructured":"Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C et al (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123:74\u201381. https:\/\/doi.org\/10.1007\/s00402-002-0465-94","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"4473_CR4","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/BOT.0b013e3181920e5b","volume":"23","author":"F Brunner","year":"2009","unstructured":"Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P et al (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163\u2013172. https:\/\/doi.org\/10.1097\/BOT.0b013e3181920e5b","journal-title":"J Orthop Trauma"},{"key":"4473_CR5","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.injury.2016.01.0046","volume":"47","author":"JC Katthagen","year":"2016","unstructured":"Katthagen JC, Schwarze M, Warnhoff M, Voigt C, Hurschler C, Lill H (2016) Influence of plate material and screw design on stiffness and ultimate load of locked plating in osteoporotic proximal humeral fractures. Inj J Care Inj 47:617\u2013624. https:\/\/doi.org\/10.1016\/j.injury.2016.01.0046","journal-title":"Inj J Care Inj"},{"key":"4473_CR6","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1016\/j.jse.2019.02.017","volume":"28","author":"D Wincheringer","year":"2019","unstructured":"Wincheringer D, Harth J, Schmidt-Horloh\u00e9 K, Hoffmann R, Gramlich Y (2019) Complications after surgical treatment of proximal humerus fractures in the elderly\u2014an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. J Shoulder Elbow Surg 28:1674\u20131684. https:\/\/doi.org\/10.1016\/j.jse.2019.02.017","journal-title":"J Shoulder Elbow Surg"},{"key":"4473_CR7","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.clinbiomech.2014.06.008","volume":"29","author":"JC Katthagen","year":"2014","unstructured":"Katthagen JC, Schwarze M, Meyer-Kobbe J, Voigt C, Hurschler C, Lill H (2014) Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures. Clin Biomech 29:735\u2013741. https:\/\/doi.org\/10.1016\/j.clinbiomech.2014.06.008","journal-title":"Clin Biomech"},{"key":"4473_CR8","first-page":"203","volume":"49","author":"P Yang","year":"2015","unstructured":"Yang P, Zhang Y, Liu J, Xiao J, Ma LM, Zhu CR (2015) Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis. Acta Orthop Traumatol Turc 49:203\u2013209","journal-title":"Acta Orthop Traumatol Turc"},{"key":"4473_CR9","doi-asserted-by":"publisher","DOI":"10.1007\/s00402","author":"K Wegmann","year":"2019","unstructured":"Wegmann K, Harbrecht A, Hackl M, Uschok S, Leschinger T, M\u00fcller LP (2019) Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training. Arch Orthop Trauma Surg. https:\/\/doi.org\/10.1007\/s00402","journal-title":"Arch Orthop Trauma Surg"},{"issue":"21","key":"4473_CR10","doi-asserted-by":"publisher","first-page":"00093","DOI":"10.1016\/j.jse.2020.12.027","volume":"S1058\u20132746","author":"N Ott","year":"2021","unstructured":"Ott N, Harland A, Hackl M, M\u00fcller LP, Wegmann K (2021) Periprosthetic humeral fractures after rTSA: is long stem revision arthroplasty the most stable solution? A biomechanical investigation. J Shoulder Elbow Surg S1058\u20132746(21):00093\u201300098. https:\/\/doi.org\/10.1016\/j.jse.2020.12.027","journal-title":"J Shoulder Elbow Surg"},{"key":"4473_CR11","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1177\/230949901402200215","volume":"22","author":"NG Burke","year":"2014","unstructured":"Burke NG, Kennedy J, Cousins G, Fitzpatrick D, Mullett H (2014) Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study. J Orthop Surg 22:190\u2013194. https:\/\/doi.org\/10.1177\/230949901402200215","journal-title":"J Orthop Surg"},{"key":"4473_CR12","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1080\/17453670710014031","volume":"78","author":"GN Duda","year":"2007","unstructured":"Duda GN, Epari DR, Babst R, Lambert SM, Matthys R, Sudkamp NP (2007) Mechanical evaluation of a new minimally invasive device for stabilization of proximal humeral fractures in elderly patients\u2014a cadaver study. Acta Orthop 78:430\u2013435. https:\/\/doi.org\/10.1080\/17453670710014031","journal-title":"Acta Orthop"},{"key":"4473_CR13","doi-asserted-by":"publisher","first-page":"E188","DOI":"10.1097\/BOT.0b013e31823db922","volume":"26","author":"JB Erhardt","year":"2012","unstructured":"Erhardt JB, Stoffel K, Kampshoff J, Badur N, Yates P, Kuster MS (2012) The position and number of screws influence screw perforation of the humeral head in modern locking plates: a cadaver study. J Orthop Trauma 26:E188\u2013E192. https:\/\/doi.org\/10.1097\/BOT.0b013e31823db922","journal-title":"J Orthop Trauma"},{"key":"4473_CR14","doi-asserted-by":"crossref","unstructured":"Padegimas EM, Zmistowski B, Lawrence C, Palmquist A, Nicholson TA, Namdari S (2017) Defining optimal calcar screw positioning in proximal humerus fixation. J Shoulder Elb Surg","DOI":"10.1016\/j.jse.2017.05.003"},{"issue":"3","key":"4473_CR15","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1016\/j.injury.2018.02.007","volume":"49","author":"S Mehta","year":"2018","unstructured":"Mehta S, Chin M, Sanville J, Namdari S, Hast MW (2018) Calcar screw position in proximal humerus fracture fixation: Don\u2019t miss high! Injury 49(3):624\u2013629","journal-title":"Injury"},{"key":"4473_CR16","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1097\/TA.0b013e3181beed96","volume":"69","author":"J Lescheid","year":"2010","unstructured":"Lescheid J, Zdero R, Shah S, Kuzyk PRT, Schemitsch EH (2010) The biomechanics of locked plating for repairing proximal humerus fractures with or without medial cortical support. J Trauma-Injury Infect Crit Care 69:1235\u20131242. https:\/\/doi.org\/10.1097\/TA.0b013e3181beed96","journal-title":"J Trauma-Injury Infect Crit Care"},{"key":"4473_CR17","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1016\/j.injury.2016.02.028","volume":"47","author":"YK Zhang","year":"2016","unstructured":"Zhang YK, Wei HW, Lin KP, Chen WC, Tsai CL, Lin KJ (2016) Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: a finite element analysis. Injury 47:1191\u20131195. https:\/\/doi.org\/10.1016\/j.injury.2016.02.028","journal-title":"Injury"},{"key":"4473_CR18","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00202","volume":"95","author":"BA Ponce","year":"2011","unstructured":"Ponce BA, Thompson KJ, Raghava P (2011) The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Jt Surg Am 95:e113. https:\/\/doi.org\/10.2106\/JBJS.K.00202","journal-title":"J Bone Jt Surg Am"},{"issue":"3","key":"4473_CR19","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1302\/0301-620X.94B3.27550","volume":"94","author":"K Seide","year":"2012","unstructured":"Seide K, Aljudaibi M, Weinrich N, Kowald B, J\u00fcrgens C, M\u00fcller J, Faschingbauer M (2012) Telemetric assessment of bone healing with an instrumented internal fixator. J Bone Jt Surg 94(3):398\u2013404. https:\/\/doi.org\/10.1302\/0301-620X.94B3.27550","journal-title":"J Bone Jt Surg"},{"key":"4473_CR20","doi-asserted-by":"publisher","first-page":"S-B-37","DOI":"10.1016\/S0020-1383(00)80042-X","volume":"31","author":"K Stoffel","year":"2000","unstructured":"Stoffel K, Klaue K, Perren SM (2000) Functional load of plates in fracture fixation on vivo and is correlate in bone healing. Injury Int J Care Injured 31:S-B-37-S-B-50","journal-title":"Injury Int J Care Injured"},{"key":"4473_CR21","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1007\/s00402-007-0512-7","volume":"1","author":"K Seide","year":"1999","unstructured":"Seide K, Morlock MM, Schuemann U, Wolter D (1999) Mechanical effects of the locked screw plate interface in internal fixator osteosynthesis. Trauma Berufskrankh 1:320\u2013325. https:\/\/doi.org\/10.1007\/s00402-007-0512-7","journal-title":"Trauma Berufskrankh"},{"key":"4473_CR22","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/BOT.0b013e318225b875","volume":"25","author":"JL Cartner","year":"2011","unstructured":"Cartner JL, Hartsell ZM, Ricci WM, Tornetta P (2011) Can we trust ex vivo mechanical testing of fresh-frozen cadaveric specimens? The effect of postfreezing delays. J Orthop Trauma 25:459\u2013461. https:\/\/doi.org\/10.1097\/BOT.0b013e318225b875","journal-title":"J Orthop Trauma"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04473-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-022-04473-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04473-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T12:07:55Z","timestamp":1681733275000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-022-04473-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,30]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["4473"],"URL":"https:\/\/doi.org\/10.1007\/s00402-022-04473-7","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,30]]},"assertion":[{"value":"17 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"These authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Institutional ethics committee approval was given prior to this study (VT 20 \u2013 1002).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No grant or grant support.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}