Is humeral segmental defect replacement device a stronger construct than locked IM nailing?

Intramedullary (IM) nailing is currently the most common method for treating patients with impending pathologic humeral fractures; however, this treatment is associated with known complications primarily owing to violation of the rotator cuff during insertion. A better option is needed. To determine if a humeral segmental replacement prosthesis would provide a stronger construct compared with an IM nail in this setting, we compared the mechanical properties of these two devices in a cadaver model simulating an impending pathologic fracture. In each of nine matched pairs of fresh human humeri one was randomly selected to undergo a 50% lateral middiaphyseal defect simulating an impending pathologic fracture and subsequent fixation with an IM nail and bone cement. The contralateral humerus underwent fixation using a humeral segmental defect prosthesis. We determined T-scores using DEXA. Each specimen subsequently was tested in torsion to failure. Peak torque and peak rotation at failure were greater for the prosthesis specimens whereas torsional stiffness was greater for the IM nail specimens. We found a linear relationship between peak torque and T-score for each device with the slopes of the lines suggesting the construct with the prosthesis can withstand greater forces than the IM nail and the differences between devices were greater in weaker bones.

Finite-element modeling of the anthropoid mandible: the effects of altered boundary conditions.

Finite-element modeling provides a full-field method for describing the stress environment of the skull. The utility of finite-element models, however, remains uncertain given our ignorance of whether such models validly portray states of stress and strain. For example, the effects of boundary conditions that are chosen to represent the mechanical environment in vivo are largely unknown. We conducted an in vitro strain gauge experiment on a fresh, fully dentate adult mandible of Macaca fascicularis to model a simplified loading regime by finite-element analysis for purposes of model validation. Under various conditions of material and structural complexity, we constructed dentate and edentulous models to measure the effects of changing boundary conditions (force orientation and nodal constraints) on strain values predicted at the gauge location. Our results offer a prospective assessment of the difficulties encountered when attempting to validate finite-element models from in vivo strain data. Small errors in the direction of load application produce significant changes in predicted strains. An isotropic model, although convenient, shows poor agreement with experimental strains, while a heterogeneous orthotropic model predicts strains that are more congruent with these data. Most significantly, we find that an edentulous model performs better than a dentate one in recreating the experimental strains. While this result is undoubtedly tied to our failure to model the periodontal ligament, we interpret the finding to mean that in the absence of occlusal loads, teeth within alveoli do not contribute significantly to the structural stiffness of the mandible.