{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T02:27:27Z","timestamp":1794018447180,"version":"4.8.0"},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To investigate the biomechanical competence of locked plating augmented with supplemental intramedullary graft in comparison to conventional locked plate fixation in proximal humerus fractures (PHF).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Complex four-part PHFs were set in 30 artificial humeri assigned to 3 study groups (n = 10 in each group). Group 1 was characterized by loss of medial support, group 2 by simulated severe cancellous bone damage due to osteoporosis, and group 3 by combination of the 2 features. After locked plating, each specimen underwent nondestructive quasi-static mechanical testing in 25 degrees lateral angulation under axial loading between 150 and 400 N in 50-N increments, accompanied by consecutive anteroposterior x-ray imaging. Subsequently, an additional 3D-printed intramedullary graft was inserted into each specimen and all tests were repeated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Grafting resulted in significantly higher axial stiffness compared with no graft in groups 1 and 3 (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01) but not in group 2 (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.12). Nongrafted specimens represented significantly higher stiffness in group 2 compared with groups 1 and 3 (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01), whereas no significant differences were detected among the 3 groups in the grafted state (<jats:italic toggle=\"yes\">P<\/jats:italic> &gt; 0.99). Varus deformation decreased significantly in each group after graft insertion (<jats:italic toggle=\"yes\">P<\/jats:italic> \u2264 0.04). Nongrafted specimens in group 2 showed significantly lower varus deformation compared with groups 1 and 3 (<jats:italic toggle=\"yes\">P<\/jats:italic> \u2264 0.04). No significant differences were registered among the 3 groups after grafting (<jats:italic toggle=\"yes\">P<\/jats:italic> \u2265 0.65).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>From a biomechanical perspective, locked plating augmented with intramedullary graft has the potential to increase significantly the stability against varus collapse in unstable PHFs when compared with conventional locked plate fixation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000001376","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T01:16:20Z","timestamp":1546564580000},"page":"196-202","source":"Crossref","is-referenced-by-count":16,"title":["Does Supplemental Intramedullary Grafting Increase Stability of Plated Proximal Humerus Fractures?"],"prefix":"10.1097","volume":"33","author":[{"given":"Lyubomir","family":"Rusimov","sequence":"first","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland;"},{"name":"Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u201cN. I. Pirogov,\u201d Sofia, Bulgaria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ciric","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland;"},{"name":"Flinders University, Tonesly, South Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan P.","family":"Barcik","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dian","family":"Enchev","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u201cN. I. Pirogov,\u201d Sofia, Bulgaria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihail","family":"Rashkov","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u201cN. I. Pirogov,\u201d Sofia, Bulgaria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariya","family":"Hadzhinikolova","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland;"},{"name":"Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u201cN. I. Pirogov,\u201d Sofia, Bulgaria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoff","family":"Richards","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asen","family":"Baltov","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u201cN. I. 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