{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:45:52Z","timestamp":1787067952759,"version":"build-2736575974"},"reference-count":51,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002511","name":"Konyang University","doi-asserted-by":"crossref","award":["2025A0022"],"award-info":[{"award-number":["2025A0022"]}],"id":[{"id":"10.13039\/501100002511","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Adding a fibular strut bone graft to locking plate fixation has been introduced to improve stability and prevent varus collapse. The purpose of this study was to perform finite element analysis (FEA) of the biomechanical characteristics of different insertion angles of the fibular strut graft in proximal humerus fractures. Proximal humerus fractures with metaphyseal comminution and instability were simulated by creating wedge-shaped osteotomies medially and laterally for varus and valgus models, respectively. Three-dimensional finite element models were reconstructed from computed tomography images. A locking compression plate with a length of 90 mm (three holes) was applied to the proximal humerus fracture model. Fibular allografts were inserted at 0\u00b0 and 30\u00b0 to the humeral shaft. Axial and traction forces of 70\u00b0, 90\u00b0, and 110\u00b0 relative to the vertical axis were applied to each model to simulate stress on the plate and graft. At axial loads, stresses in both the plate and the graft were lower when the graft was inserted at 0\u00b0 than at 30\u00b0. Under traction loads, plate stress was lower with 30\u00b0 insertion. Graft stress was also lower with 30\u00b0 in most experimental conditions in both the valgus and varus models. These findings suggest that oblique insertion may provide biomechanical advantages under traction forces in unstable proximal humerus fractures.<\/jats:p>","DOI":"10.3390\/bioengineering12101078","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:22:47Z","timestamp":1759483367000},"page":"1078","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Optimal Fibular Strut Bone Graft Fixation Angle for Unstable Proximal Humerus Fractures: A Finite Element Analysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7844-2293","authenticated-orcid":false,"given":"Hyun Seok","family":"Song","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4436-4503","authenticated-orcid":false,"given":"Hui-Gyeong","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Konyang University, 158 Gwanjeodong-ro, Daejeon 35365, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Ju","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Konyang University, 158 Gwanjeodong-ro, Daejeon 35365, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3400-0263","authenticated-orcid":false,"given":"Hyungsuk","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki-Sik","family":"Tae","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Konyang University, 158 Gwanjeodong-ro, Daejeon 35365, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref_1","first-page":"CD000434","article-title":"Interventions for treating proximal humeral fractures in adults","volume":"11","author":"Handoll","year":"2015","journal-title":"Cochrane Database Syst. 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