{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T05:40:02Z","timestamp":1768801202939,"version":"3.49.0"},"reference-count":49,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T00:00:00Z","timestamp":1693872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AO Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects\u2014weakening the osteosynthesis construct\u2014are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomechanical study aimed to analyze the stability of plated unstable PHFs augmented via implementation of this technique versus no augmentation. Materials and Methods: Three-part AO\/OTA 11-B1.1 unstable PHFs with metaphyseal defects were created in sixteen paired human cadaveric humeri (average donor age 76 years, range 66\u201392 years), pairwise assigned to two groups for locked plate fixation with identical implant configuration. In one of the groups, six-milliliter polymethylmethacrylate bone cement with medium viscosity (seven minutes after mixing) was placed manually through the lateral window in the defect of the humerus head after its anatomical reduction to the shaft and prior to the anatomical reduction of the greater tuberosity fragment. All specimens were tested biomechanically in a 25\u00b0 adduction, applying progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary movements were monitored by motion tracking and X-ray imaging. Results: Initial stiffness was not significantly different between the groups, p = 0.467. Varus deformation of the humerus head fragment, fracture displacement at the medial humerus head aspect, and proximal screw migration and cut-out were significantly smaller in the augmented group after 2000, 4000, 6000, 8000 and 10,000 cycles, p \u2264 0.019. Cycles to 5\u00b0 varus deformation of the humerus head fragment\u2014set as a clinically relevant failure criterion\u2014and failure load were significantly higher in the augmented group, p = 0.018. Conclusions: From a biomechanical standpoint, augmentation with polymethylmethacrylate bone cement placed in the metaphyseal humerus head defect of plated unstable PHFs considerably enhances fixation stability and can reduce the risk of postoperative complications.<\/jats:p>","DOI":"10.3390\/medicina59091604","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T09:46:20Z","timestamp":1693907180000},"page":"1604","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique\u2014A Biomechanical Cadaveric Study"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4113-6226","authenticated-orcid":false,"given":"Daniel","family":"Zhelev","sequence":"first","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"},{"name":"Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6118-315X","authenticated-orcid":false,"given":"Stoyan","family":"Hristov","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0484-887X","authenticated-orcid":false,"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-2766","authenticated-orcid":false,"given":"Stoyan","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Medical University of Varna, 9002 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0031-0805","authenticated-orcid":false,"given":"Luke","family":"Visscher","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"},{"name":"School of Medicine, Queensland University of Technology, Brisbane 4000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asen","family":"Baltov","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u2018N. I. Pirogov\u2019, 1606 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0251-3251","authenticated-orcid":false,"given":"Simeon","family":"Ribagin","sequence":"additional","affiliation":[{"name":"Department of Health Pharmaceutical Care, Medical College, University \u2018Prof. Dr. Asen Zlatarov\u2019, 8010 Burgas, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4431-3626","authenticated-orcid":false,"given":"Karl","family":"Stoffel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6835-1761","authenticated-orcid":false,"given":"Franz","family":"Kralinger","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Trauma and Sports Department, Ottakring Clinic, Teaching Hospital, Medical University of Vienna, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Winkler","sequence":"additional","affiliation":[{"name":"Cantonal Hospital Graubuenden, 7000 Chur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-2480","authenticated-orcid":false,"given":"R. Geoff","family":"Richards","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2738-6436","authenticated-orcid":false,"given":"Peter","family":"Varga","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-115X","authenticated-orcid":false,"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1186\/s13018-021-02551-x","article-title":"Epidemiology of proximal humerus fractures","volume":"16","year":"2021","journal-title":"J. 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