{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:09:34Z","timestamp":1790834974449,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272455"],"award-info":[{"award-number":["82272455"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Intramedullary nailing is preferred for treating elderly proximal humeral fractures, but secondary reductions are common, particularly in elderly and osteoporotic patients. This occurs due to the intramedullary nail fixation's insufficient anti\u2010varus and anti\u2010rotational capacities and high stress at the bone\u2013implant interface. We aim to enhance the anti\u2010varus and anti\u2010rotational stability of the fixation structure while reducing the stresses on the bone and internal fixation through structural design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We developed a novel endosteal anatomical support nail (EASN) that integrates an endosteal torus construct into the proximal portion of the angle\u2010stable proximal humerus nail. The endosteal torus construct includes endosteal anatomical support (EAS) with a flat plane that allows direct fixation of the humeral head fragments and is shaped to conform to the medial side of the medullary cavity of the proximal humerus. We conducted finite element analysis to assess the biomechanical stability of four constructs: EAS with a calcar screw (CS), EAS without CS, non\u2010EAS with CS, and non\u2010EAS without CS. This analysis determined the contribution of the EAS to the mechanical stability of the proximal humerus in two\u2010part PHF with medial column disruption. Specimens were subjected to loads simulating partial\u2010weight\u2010bearing (as in rising from a chair or using crutches) and full\u2010weight\u2010bearing (as in rising from bed). We evaluated the stiffness of the construct, displacement at the fracture site, von Mises stress, and stress distribution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Under compressive or rotational loads, the EAS construct, with or without CS, was significantly stiffer than the non\u2010EAS construct. Displacement at the fracture site was significantly less with the EAS fixation than with the non\u2010EAS fixation. However, the stiffness and displacement at the fracture site of the EAS fixation without CS were comparable to those of the non\u2010EAS construct with CS. The EAS construct reduced the load on the nail and decreased the risk of implant failure. Both von Mises stress and stress distribution were significantly lower following fixation with the EAS constructs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study introduces a novel EAS concept to enhance the anti\u2010varus and anti\u2010rotational capabilities of the humeral head and distribute stress at the bone\u2013implant interface in treating elderly PHFs. This strategy shows promise based on our limited analysis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14297","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T10:41:17Z","timestamp":1732704077000},"page":"551-562","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced Biomechanical Stability in Proximal Humeral Fractures: Finite Element Analysis of a Novel Endosteal Anatomical Support Nail for Improved Fixation in Elderly Patients"],"prefix":"10.1111","volume":"17","author":[{"given":"Jiawen","family":"Chen","sequence":"first","affiliation":[{"name":"Chinese PLA Medical School  Beijing China"},{"name":"The Department of Orthopaedic Surgery Fourth Medical Center for Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhonghe","family":"Wang","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedic Surgery Fourth Medical Center for Chinese PLA General Hospital  Beijing China"},{"name":"Ningxia Medical University  Yinchuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changda","family":"Li","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedic Surgery Fourth Medical Center for Chinese PLA General Hospital  Beijing China"},{"name":"Ningxia Medical University  Yinchuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiyu","family":"He","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedic Surgery Fourth Medical Center for Chinese PLA General Hospital  Beijing China"},{"name":"First Clinical Medical College Inner Mongolia Medical University  Hohhot China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongxuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Sun","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedic Surgery Fourth Medical Center for Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Cao","sequence":"additional","affiliation":[{"name":"Beijing Engineering Laboratory of Functional Medical Materials and Devices  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Tian","sequence":"additional","affiliation":[{"name":"Beijing Engineering Laboratory of Functional Medical Materials and Devices  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Beijing Engineering Laboratory of Functional Medical Materials and Devices  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peifu","family":"Tang","sequence":"additional","affiliation":[{"name":"Chinese PLA Medical School  Beijing China"},{"name":"The Department of Orthopaedic Surgery Fourth Medical Center for Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-6742","authenticated-orcid":false,"given":"Hua","family":"Chen","sequence":"additional","affiliation":[{"name":"Chinese PLA Medical School  Beijing China"},{"name":"The Department of Orthopaedic Surgery Fourth Medical Center for Chinese PLA General Hospital  Beijing China"},{"name":"Ningxia Medical University  Yinchuan China"},{"name":"First Clinical Medical College Inner Mongolia Medical University  Hohhot China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"issue":"23","key":"e_1_2_11_2_1","article-title":"Complications and Long\u2010Term Outcomes of Open Reduction and Plate Fixation of Proximal Humeral Fractures","volume":"101","author":"Cil A.","year":"2019","journal-title":"Journal of Bone and Joint Surgery (American Volume)"},{"issue":"9","key":"e_1_2_11_3_1","first-page":"829","article-title":"Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures","volume":"103","author":"Mease S. 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