RESUMO
BACKGROUND: Lateral locking plate (LLP) fixation has gained popularity for the treatment of proximal humeral fractures (PHFs); however, complications can occur due to loss of the medial cortical buttress from fracture comminution. MATERIALS AND METHODS: We designed a novel intramedullary anatomical medial strut with allograft bone (IAMSAB) using MIMICS software to specifically fill the intramedullary canal of the proximal humeral bone. We used finite element analysis to evaluate the biomechanical characteristics of a LLP, LLP-intramedullary fixation system (IFS), LLP-anatomical medial locking plate (AMLP), or the combined application of a LLP and IAMSAB (LLP-IAMSAB) fixation construct in patients with a PHF and an unstable medial column. RESULTS: For axial or rotational loads, under (normal) Nor or osteoporotic (Ost) bone conditions, the LLP-IAMSAB fixation construct was significantly stiffer than the LLP-IFS fixation construct, and displacement at the fracture site after LLP-IAMSAB fixation was significantly less than after LLP or LLP-IFS fixation (P < 0.05). Stiffness of the LLP-IAMSAB and LLP-AMLP fixation constructs and displacement at the fracture site after LLP-IAMSAB and LLP-AMLP fixation were not significantly different. The IFS, AMLP, and IAMSAB shared the load in the LLP and decreased the risk of implant failure. There were no significant differences in von Mises stress and stress distribution after fixation with the LLP-IFS, LLP-AMLP, and LLP-IAMSAB constructs. CONCLUSION: These data suggest that the IAMSAB can provide direct medial support or resistance to rotation and augment the biomechanics of the LLP. The combined application of the IAMSAB and LLP may achieve functional outcomes that are similar to the LLP-AMLP fixation construct.
Assuntos
Placas Ósseas , Transplante Ósseo/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Instabilidade Articular/cirurgia , Fraturas do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Transplante Ósseo/métodos , Estudos de Coortes , Feminino , Análise de Elementos Finitos , Fixação Intramedular de Fraturas/métodos , Fraturas Cominutivas/fisiopatologia , Fraturas Cominutivas/cirurgia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Masculino , Fraturas do Ombro/complicações , Fraturas do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgiaRESUMO
BACKGROUND: Exertional heat stroke is a fatal condition and remains a health problem. This paper evaluates the publication trend regarding exertional heat stroke research between 1996 and 2015 using a bibliometric method. METHOD: Articles regarding exertional heat stroke research published between 1996 and December 2015 were searched for in the SCI-EXPANDED database of Web of Science. The search results were analyzed with regard to publication year; publication quantity regarding countries/regions, and authors; citation frequency; and journal distribution. CiteSpace (v3.6) was used for a document co-citation visualization analysis. RESULTS: In total, 289 publications on heat stroke were located. After selection, 209 original articles conducted across 28 countries/regions and published in 83 journals were included in the analysis. The USA, Isreal, and France were the most common locations for exertional heat stroke studies. The CiteSpace visualization cluster analysis showed that exertional heat stroke-related mortality and protective measures were constant concerns of research. CONCLUSIONS: Research related to exertional heat stroke has been continuous concerned. USA is still the leading country in this field.