Anatomical Intertubercular Groove Auxiliary Plate for Proximal Humerus Fractures in Elderly Patients with Osteoporosis

For elderly individuals with osteoporosis, even a minor misstep can result in frequent visits to the orthopedics department.

Among these, proximal humeral fractures are relatively common in clinical practice. According to statistics, the incidence of proximal humeral fractures accounts for all fractures'4-5％，The incidence rate is second only to that of hip fractures and distal radius fractures.. Moreover, as the aging of the population intensifies, the incidence of proximal humeral fractures will exhibitTwo- to Three-Fold Growth。

Pain after a fracture, narrowed life scope, and the torment of being unable to care for oneself... all these gradually erode the mental well-being of the elderly. Apart from fall prevention, the only way to alleviate the situation is to help the elderly recover as soon as possible.

In addition to conservative management, common surgical treatments for proximal humeral fractures include internal fixation with plates or intramedullary nails, while reverse shoulder arthroplasty is indicated in select severe cases.Among them, internal fixation with the Philos plate is currently one of the commonly used surgical procedures in clinical practice.However, due to osteoporosis and the lack of effective medial support in elderly patients, postoperative complications such as poor fracture reduction, collapse of the humeral head, screw cut-out, and plate breakage frequently occur.

Yu Bo, Deputy Director of the Bone and Joint Injury Center, Affiliated Hospital of Shandong University of Traditional Chinese MedicineWith years of in-depth expertise in orthopedic trauma, he has observed from extensive clinical experience that adding auxiliary plates to existing surgical techniques may mitigate issues such as insufficient fixation strength caused by osteoporosis. This approach can also significantly reduce the risk of postoperative complications in elderly patients and accelerate their recovery.

According to the latest edition published by the European Society of Trauma and Emergency Surgery (ESTES)"2021 Guidelines for the Treatment of Proximal Humerus Fractures in the Elderly", currently, the standard practice for surgical treatment involves placing into the proximal humerusAt least 5 piecesLocking screws combined with medial calcar screws enhance the overall mechanical stability of the internal fixation system, effectively counteracting varus stress on the proximal humerus and maintaining fracture reduction until union.

However, since the load-bearing capacity of bones in elderly patients is significantly inferior to that of younger individuals, the treatment approach using five locking screws combined with a plate is highly prone to causing secondary injury. To address this issue, many researchers have begun investigating methods to improve postoperative stability following proximal humeral fractures in the elderly. They have pioneered techniques such as allogeneic fibular grafting and bone cement-augmented fixation to enhance bone mineral density in the fracture region and strengthen stability.

However, from a clinical perspective, this approach is technically demanding and requires a high level of surgical expertise. Furthermore, improper selection or handling of implants can increase the risk of infection and rejection, thereby raising the likelihood of surgical complications and significantly impairing shoulder joint function and quality of life.

Ultimately, the addition of an auxiliary plate has become a low-risk approach across all surgical techniques, offering excellent fixation stability and favorable recovery outcomes. Currently, auxiliary plates are typically 1/3 tubular plates or reconstruction plates, which do not impose additional technical demands on the operating surgeon and rarely cause implant rejection. However, the current design of auxiliary plates, in terms of shape and screw placement, does not conform to the anatomical characteristics of the proximal humerus. Their positioning can easily injure the long head tendon of the biceps brachii, the posterior circumflex humeral artery, and the axillary nerve. Furthermore, the auxiliary plate may interfere with the proper placement of the PHILOS plate.

To address this pain point, Director Yu designed aAnatomical Auxiliary Plate for the Intertubercular Sulcus of the Proximal Humerus, to address the existing pain points of current auxiliary plates.

Director Yu introduced, “This product, which utilizesMimics Digital SoftwareDesign and develop a low-profile, divergent-locking ‘Anatomic Bicipital Groove-Assist Plate for the Humerus’ to facilitate reduction, provide adequate mechanical support to the medial calcar of the humerus, and enhance stability.Patent has been granted.”

From an external perspective, the most prominent feature of the “Anatomical Auxiliary Plate for the Bicipital Groove of the Humerus,” designed by Director Yu, is its “small” size. The advantage of this compact appearance translates to easier implantation during surgery compared to conventional auxiliary plates,The procedural difficulty and risks are also reduced.

“The anatomical auxiliary plate for the bicipital groove of the humerus” can be implanted under the surgical field conditions of the main plate,No need to increase exposure of the surgical field.Additionally, intraoperatively, it is common toReduction Using the Intertubercular Sulcus as a Landmark for Medial Anatomical Reduction of the Proximal Humerus“The anatomical auxiliary plate for the intertubercular groove of the humerus” can be placed laterally to the intertubercular groove to assist in reduction and fixation. Furthermore, this approach facilitates intraoperative fluoroscopic visualization of the shoulder joint in multiple planes, including internal and external rotation, as well as adduction and abduction. Meanwhile, the auxiliary plate features an ergonomic design that neither interferes with the placement of the primary plate nor causes injury to surrounding structures such as the long head tendon of the biceps brachii, the posterior circumflex humeral artery, and the axillary nerve.Postoperative shoulder joint mobility remains unaffected, facilitating patient recovery.

However, the advantages of intraoperative manipulation do not encompass the full scope of the “anatomic bicipital groove auxiliary plate”; its primary role remains to enhance stability.

Regarding this point, Director Yu revealed to VCBeat’s Orange Bureau: “Based on the clinical trials we have completed so far, the ‘anatomical auxiliary plate for the bicipital groove of the humerus’ can provide greater structural stiffness and stability.”

Moreover, this auxiliary plate can effectively distribute the forces acting on the humerus, reducing the risk of internal fixation failure. This results in shorter healing times and better postoperative recovery of shoulder joint function.

Overall, the “anatomically designed auxiliary plate for the bicipital groove of the humerus” demonstrates advantages in terms of stability, ease of operation, and even patient recovery.

With the continuous advancement of integrating traditional Chinese and Western medicine in clinical practice, Director Yu from the Affiliated Hospital of Shandong University of Traditional Chinese Medicine has leveraged his expertise to apply modern TCM“Microscopic Pattern Differentiation”The philosophy is integrated therein.

“Microscopic Syndrome Differentiation” was first proposed by Academician Shen Ziyin in 1986. In simple terms, “Microscopic Syndrome Differentiation” involves introducing advanced technologies from modern medicine into Traditional Chinese Medicine (TCM), thereby elucidating the material basis of TCM syndromes more comprehensively, accurately, and fundamentally.

In Director Yu’s view, the integration of traditional Chinese medicine (TCM) and Western medicine is not limited to pharmaceuticals but extends to diagnostic approaches and therapeutic methods. Therefore, Director Yu has incorporated modern medical techniques into the field of TCM orthopedics and traumatology, employing finite element analysis to elucidate micro-pattern differentiation in bone and joint injuries."Stable"concept, this auxiliary plate was designed.

Currently, the auxiliary plate designed by Director Yu has received unanimous acclaim within the hospital, which has also provided policy and financial support to facilitate its translation into clinical practice. However, as a clinician, Director Yu still finds himself constrained by the limitations of his professional network.The biggest challenge facing this project at present is the lack of a mechanical design team for long-term collaboration.

“Although several prototypes of the ‘anatomical auxiliary plate for the bicipital groove of the humerus’ have been developed, Director Yu believes that by leveraging the expertise of a professional engineering design team, further improvements could be made in areas such as material selection and stress distribution across the plate to better align with clinical needs.”

Perhaps the design of the “Anatomical Auxiliary Plate for the Intertubercular Sulcus of the Humerus” does not represent a monumental leap, but Professor Yu states, “Minor design innovations can often be translated into clinical practice more rapidly, thereby providing patients with an improved treatment experience. Therefore, I firmly believe that the accumulation of such incremental designs will also drive progress and transformation in healthcare.” Supported by this conviction, Director Yu looks forward to the early clinical adoption of the “Anatomical Auxiliary Plate for the Intertubercular Sulcus of the Humerus,” ultimately benefiting patients.