Anterolateral Dual Plate Fixation for Distal Metaphyseal-Diaphyseal Junction Fractures of the Humerus: Biomechanical Finite Element Analysis with Clinical Results.

Background: Distal metaphyseal-diaphyseal junction fractures of the humerus are a subset of injuries between humeral shaft fractures and distal intra-articular humerus fractures. A lack of space for distal fixation and the unique anatomy of concave curvature create difficulties during operative treatment. The closely lying radial nerve is another major concern. The aim of this study was to determine whether anterolateral dual plate fixation could be effective for a distal junctional fracture of the humerus both biomechanically and clinically. Methods: A right humerus 3-dimensional (3D) model was obtained based on plain radiographs and computed tomography data of patients. Two fractures, a spiral type and a spiral wedge type, were constructed. Three-dimensional models of locking compression plates and screws were constructed using materials provided by the manufacturer. The experiment was conducted by using COMSOL Multiphysics, a finite element analysis, solver, and simulation software package. For the clinical study, from July 2008 to March 2021, a total of 72 patients were included. Their medical records were retrospectively reviewed to obtain patient demographics, elbow range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) scores, Mayo Elbow Performance Scores (MEPS), and hand grip strength. Results: No fracture fixation construct completely restored stiffness comparable to the intact model in torsion or compression. Combinations of the 7-hole and 5-hole plates and the 8-hole and 6-hole plates showed superior structural stiffness and stress than those with single lateral plates. At least 3 screws (6 cortices) should be inserted into the lateral plate to reduce the load effectively. For the anterior plate, it was sufficient to purchase only the near cortex. Regarding clinical results of the surgery, the range of motion showed satisfactory results in elbow flexion, elbow extension, and forearm rotation. The average DASH score was 4.3 and the average MEPS was 88.2. Conclusions: Anterolateral dual plate fixation was biomechanically superior to the single-plate method in the finite element analysis of a distal junctional fracture of the humerus model. Anterolateral dual plate fixation was also clinically effective in a large cohort of patients with distal junctional fractures of the humerus.

Augmenting Perceived Softness of Haptic Proxy Objects Through Transient Vibration and Visuo-Haptic Illusion in Virtual Reality.

In this article, we investigate the effects of active transient vibration and visuo-haptic illusion to augment the perceived softness of haptic proxy objects. We introduce a system combining active transient vibration at the fingertip with visuo-haptic illusions. In our hand-held device, a voice coil actuator transmits active transient vibrations to the index fingertip, while a force sensor measures the force applied on passive proxy objects to create visuo-haptic illusions in virtual reality. We conducted three user studies to understand both the vibrotactile effect and its combined effect with visuo-haptic illusions. A preliminary study confirmed that active transient vibrations can intuitively alter the perceived softness of a proxy object. Our first study demonstrated that those same active transient vibrations can generate different perceptions of softness depending on the material of the proxy object used. In our second study, we evaluated the combination of active transient vibration and visuo-haptic illusion, and found that both significantly influence perceived softness, with with the visuo-haptic effect being dominant. Our third study further investigated the vibrotactile effect while controlling for the visuo-haptic illusion. The combination of these two methods allows users to effectively perceive various levels of softness when interacting with haptic proxy objects.