Biomechanical advantages of personalized Y-shaped plates in treatment of distal humeral intra-articular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Hao ¹ ,  PENG Jiachen ¹ , YANG Jibin ¹ , YANG Lidan ¹ , XU Zhi ² , YANG Chen ³

1. Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China;
2. Department of Orthopedics, Zhangjiagang Fifth People’s Hospital, Zhangjiagang Jiangsu, 215600, P. R. China;
3. College of Sports and Health, Shandong Sports University, Ji’nan Shandong, 250100, P. R. China;

Corresponding author：

PENG Jiachen, Email: 13511885288@139.com

Keywords：

Distal humerus fracture; Y-shaped plate; internal fixation; finite element analysis; biomechanical properties

DOI：

10.7507/1002-1892.202503066

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the biomechanical properties of personalized Y-shaped plates with horizontal plates, vertical plates, and traditional Y-shaped plates in the treatment of distal humeral intra-articular fractures through finite element analysis, and to evaluate their potential for clinical application. Methods The study selected a 38-year-old male volunteer and obtained a three-dimensional model of the humerus by scanning his upper limbs using a 64-slice spiral CT. Four types of fracture-internal fixation models were constructed using Mimics 19.0, Geomagic Wrap 2017, Creo 6.0, and other software: horizontal plates, vertical plates, traditional Y-shaped plate, and personalized Y-shaped plate. The models were then meshed using Hypermesh 14.0 software, and material properties and boundary conditions were defined in Abaqus 6.14 software. AnyBody 7.3 software was used to simulate elbow flexion and extension movements, calculate muscle strength, joint forces, and load torques, and compare the peak stress and maximum displacement of the four fixation methods at different motion angles (10°, 30°, 50°, 70°, 90°, 110°, 130°, 150°) during elbow flexion and extension.Results Under dynamic loading during elbow flexion and extension, the personalized Y-shaped plate exhibits significant biomechanical advantages. During elbow flexion, the peak internal fixation stress of the personalized Y-shaped plate was (28.8±0.9) MPa, which was significantly lower than that of the horizontal plates, vertical plates, and traditional Y-shaped plate (P<0.05). During elbow extension, the peak internal fixation stress of the personalized Y-shaped plate was (18.1±1.6) MPa, which was lower than the other three models, with significant differences when compared with horizontal plates and vertical plates (P<0.05). Regarding the peak humeral stress, the personalized Y-shaped plate model showed mean values of (10.9±0.8) and (13.1±1.4) MPa during elbow flexion and extension, respectively, which were significantly lower than those of the other three models (P<0.05). Displacement analysis showed that the maximum displacement of the humerus with the personalized Y-shaped plate during elbow flexion was (2.03±0.08) mm, slightly higher than that of the horizontal plates, but significantly lower than that of the vertical plates, showing significant differences (P<0.05). During elbow extension, the maximum displacement of the humerus with the personalized Y-shaped plate was (1.93±0.13) mm, which was lower than that of the other three models, with significant differences when compared with vertical plates and traditional Y-shaped plates (P<0.05). Stress contour analysis showed that the stress of the personalized Y-shaped plate was primarily concentrated at the bifurcation of the Y-shaped structure. Displacement contour analysis showed that the personalized Y-shaped plate effectively controled the displacement of the distal humerus during both flexion and extension, demonstrating excellent stability. Conclusion The personalized Y-shaped plate demonstrates excellent biomechanical performance in the treatment of distal humeral intra-articular fractures, with lower stress and displacement, providing more stable fixation effects.

1.	Kong L, Wang Y, Lu Q, et al. Biomechanical properties of a novel fixation system for intra-articular distal humerus fractures: a finite element analysis. J Orthop Surg Res, 2021, 16(1): 674. doi: 10.1186/s13018-021-02836-1.
2.	Dumartinet-Gibaud R, Lancigu R, De Sainte Hermine P, et al. Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures. Orthop Traumatol Surg Res, 2021, 107(2): 102641. doi: 10.1016/j.otsr.2020.02.022.
3.	胡喜春, 黄长明, 范华强, 等. 经尺骨鹰嘴截骨入路与经肱三头肌内外侧入路双钢板内固定治疗AO-C型肱骨远端骨折疗效比较. 中国骨与关节损伤杂志, 2022, 37(11): 1191-1194.
4.	方锐, 郭建平. 经尺骨鹰嘴截骨入路双钢板内固定治疗AO-C型肱骨远端骨折的效果及对肘肩关节功能、肌力恢复的影响. 临床医学研究与实践, 2024, 9(3): 74-77.
5.	Dirckx M, Tathgar A, Bellringer S, et al. Hemiarthroplasty versus open reduction internal fixation for intra-articular distal humerus fractures in older patients. Shoulder Elbow, 2023, 15(1): 83-92.
6.	Zhao W, Yuan H, Zhang Y, et al. A novel configuration for the fixation of intra-articular C2.3 distal humerus fractures with the potential for minimally invasive surgery: a biomechanical evaluation and finite element analysis. J Shoulder Elbow Surg, 2024, 33(5): 1138-1149.
7.	Yetter TR, Weatherby PJ, Somerson JS. Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis. J Shoulder Elbow Surg, 2021, 30(8): 1957-1967.
8.	Zalavras CG, Vercillo MT, Jun BJ, et al. Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Shoulder Elbow Surg, 2011, 20(1): 12-20.
9.	Taylor PA, Owen JR, Benfield CP, et al. Parallel plating of simulated distal humerus fractures demonstrates increased stiffness relative to orthogonal plating with a distal humerus locking plate system. J Orthop Trauma, 2016, 30(4): e118-e122.
10.	王众, 贾永鹏, 陈学强, 等. 双锁定钢板内固定与“Y”型钢板内固定治疗肱骨远端“C”型骨折的疗效比较. 中国矫形外科杂志, 2013, 21(6): 547-550.
11.	Barret H, Ceccarelli R, D’Allais PV, et al. Comparative study of a Y- anatomical and innovative locking plate versus double plate for supracondylar humeral fracture. Orthop Traumatol Surg Res, 2023, 109(5): 103380. doi: 10.1016/j.otsr.2022.103380.
12.	Adamović P, Kalajžić L, Hrman D, et al. Biomechanical analysis of a novel Y-plate designed for the treatment of extraarticular distal humerus fractures. Injury, 2023, 54(7): 110840. doi: 10.1016/j.injury.2023.110840.
13.	王世坤, 辛雷, 杨晨, 等. 基于因子回归分析研究影响棒球击球机械能的下肢生物力学因素. 医用生物力学, 2024, 39(4): 593-599.
14.	Peitola JPJ, Esrafilian A, Eskelinen ASA, et al. Sensitivity of knee cartilage biomechanics in finite element analysis to selected musculoskeletal models. Comput Methods Biomech Biomed Engin, 2024, 4: 1-12.
15.	Zhang Y, Chen Z, Zhao D, et al. Articular geometry can affect joint kinematics, contact mechanics, and implant-bone micromotion in total ankle arthroplasty. J Orthop Res, 2023, 41(2): 407-417.
16.	万昌涛, 王显勋. 软性固定结合空心螺钉固定治疗C3型肱骨远端骨折. 武汉大学学报(医学版), 2023, 44(3): 360-363.
17.	徐志, 刘子铭, 李豫皖, 等. 多孔结构设计人工踝关节衬垫生物力学的优化方案. 中国组织工程研究, 2024, 28(30): 4817-4824.
18.	王磊, 王清, 张申申. 有限元分析不同内固定方式治疗肱骨近端骨折的力学差异. 中国组织工程研究, 2025, 29(15): 3101-3109.
19.	万谦. 反式肩关节假体聚乙烯垫片脱位原因的有限元分析. 长春: 吉林大学, 2023.
20.	Peng MJ, Ju X, Ma L, et al. Dynamics analysis for flexion and extension of elbow joint motion based on musculoskeletal model of Anybody. Int J Med Robot, 2021, 17(6): e2321. doi: 10.1002/rcs.2321.
21.	徐志, 李豫皖, 邹刚, 等. 人工踝关节弹性化改良衬垫的有限元分析. 中国修复重建外科杂志, 2023, 37(11): 1361-1369.
22.	Zarifian A, Akbarinezhad Fough A, Eygendaal D, et al. Length of plates and number of screws for the fixation of distal humerus fractures: A finite element biomechanical study. J Hand Surg (Am), 2022, 47(7): 690.e1-690.e11.
23.	Zdero R, Brzozowski P, Schemitsch EH. Biomechanical design optimization of distal humerus fracture plates: A review. Biomed Res Int, 2024, 2024: 6015794. doi: 10.1155/2024/6015794.
24.	Penzkofer R, Hungerer S, Wipf F, et al. Anatomical plate configuration affects mechanical performance in distal humerus fractures. Clin Biomech (Bristol), 2010, 25(10): 972-978.
25.	Got C, Shuck J, Biercevicz A, et al. Biomechanical comparison of parallel versus 90-90 plating of bicolumn distal humerus fractures with intra-articular comminution. J Hand Surg (Am), 2012, 37(12): 2512-2518.
26.	Kudo T, Hara A, Iwase H, et al. Biomechanical properties of orthogonal plate configuration versus parallel plate configuration using the same locking plate system for intra-articular distal humeral fractures under radial or ulnar column axial load. Injury, 2016, 47(10): 2071-2076.
27.	Druel T, Burnier M, Herzberg G. Long dorsal “Y-shaped” plate for distal diaphyseal humeral fractures. Int Orthop, 2021, 45(5): 1309-1314.
28.	Bel JC. Pitfalls and limits of locking plates. Orthop Traumatol Surg Res, 2019, 105(1S): S103-S109.
29.	Aguado HJ, Mingo-Robinet J, García-Virto V, et al. AO/OTA type C3 distal humeral fractures in patients aged 75 years and older: Is ORIF with double precontoured anatomical locking plates a reliable treatment? Injury, 2023, 54 Suppl 7: 111043. doi: 10.1016/j.injury.2023.111043.

1. Kong L, Wang Y, Lu Q, et al. Biomechanical properties of a novel fixation system for intra-articular distal humerus fractures: a finite element analysis. J Orthop Surg Res, 2021, 16(1): 674. doi: 10.1186/s13018-021-02836-1.
2. Dumartinet-Gibaud R, Lancigu R, De Sainte Hermine P, et al. Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures. Orthop Traumatol Surg Res, 2021, 107(2): 102641. doi: 10.1016/j.otsr.2020.02.022.
3. 胡喜春, 黄长明, 范华强, 等. 经尺骨鹰嘴截骨入路与经肱三头肌内外侧入路双钢板内固定治疗AO-C型肱骨远端骨折疗效比较. 中国骨与关节损伤杂志, 2022, 37(11): 1191-1194.
4. 方锐, 郭建平. 经尺骨鹰嘴截骨入路双钢板内固定治疗AO-C型肱骨远端骨折的效果及对肘肩关节功能、肌力恢复的影响. 临床医学研究与实践, 2024, 9(3): 74-77.
5. Dirckx M, Tathgar A, Bellringer S, et al. Hemiarthroplasty versus open reduction internal fixation for intra-articular distal humerus fractures in older patients. Shoulder Elbow, 2023, 15(1): 83-92.
6. Zhao W, Yuan H, Zhang Y, et al. A novel configuration for the fixation of intra-articular C2.3 distal humerus fractures with the potential for minimally invasive surgery: a biomechanical evaluation and finite element analysis. J Shoulder Elbow Surg, 2024, 33(5): 1138-1149.
7. Yetter TR, Weatherby PJ, Somerson JS. Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis. J Shoulder Elbow Surg, 2021, 30(8): 1957-1967.
8. Zalavras CG, Vercillo MT, Jun BJ, et al. Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Shoulder Elbow Surg, 2011, 20(1): 12-20.
9. Taylor PA, Owen JR, Benfield CP, et al. Parallel plating of simulated distal humerus fractures demonstrates increased stiffness relative to orthogonal plating with a distal humerus locking plate system. J Orthop Trauma, 2016, 30(4): e118-e122.
10. 王众, 贾永鹏, 陈学强, 等. 双锁定钢板内固定与“Y”型钢板内固定治疗肱骨远端“C”型骨折的疗效比较. 中国矫形外科杂志, 2013, 21(6): 547-550.
11. Barret H, Ceccarelli R, D’Allais PV, et al. Comparative study of a Y- anatomical and innovative locking plate versus double plate for supracondylar humeral fracture. Orthop Traumatol Surg Res, 2023, 109(5): 103380. doi: 10.1016/j.otsr.2022.103380.
12. Adamović P, Kalajžić L, Hrman D, et al. Biomechanical analysis of a novel Y-plate designed for the treatment of extraarticular distal humerus fractures. Injury, 2023, 54(7): 110840. doi: 10.1016/j.injury.2023.110840.
13. 王世坤, 辛雷, 杨晨, 等. 基于因子回归分析研究影响棒球击球机械能的下肢生物力学因素. 医用生物力学, 2024, 39(4): 593-599.
14. Peitola JPJ, Esrafilian A, Eskelinen ASA, et al. Sensitivity of knee cartilage biomechanics in finite element analysis to selected musculoskeletal models. Comput Methods Biomech Biomed Engin, 2024, 4: 1-12.
15. Zhang Y, Chen Z, Zhao D, et al. Articular geometry can affect joint kinematics, contact mechanics, and implant-bone micromotion in total ankle arthroplasty. J Orthop Res, 2023, 41(2): 407-417.
16. 万昌涛, 王显勋. 软性固定结合空心螺钉固定治疗C3型肱骨远端骨折. 武汉大学学报(医学版), 2023, 44(3): 360-363.
17. 徐志, 刘子铭, 李豫皖, 等. 多孔结构设计人工踝关节衬垫生物力学的优化方案. 中国组织工程研究, 2024, 28(30): 4817-4824.
18. 王磊, 王清, 张申申. 有限元分析不同内固定方式治疗肱骨近端骨折的力学差异. 中国组织工程研究, 2025, 29(15): 3101-3109.
19. 万谦. 反式肩关节假体聚乙烯垫片脱位原因的有限元分析. 长春: 吉林大学, 2023.
20. Peng MJ, Ju X, Ma L, et al. Dynamics analysis for flexion and extension of elbow joint motion based on musculoskeletal model of Anybody. Int J Med Robot, 2021, 17(6): e2321. doi: 10.1002/rcs.2321.
21. 徐志, 李豫皖, 邹刚, 等. 人工踝关节弹性化改良衬垫的有限元分析. 中国修复重建外科杂志, 2023, 37(11): 1361-1369.
22. Zarifian A, Akbarinezhad Fough A, Eygendaal D, et al. Length of plates and number of screws for the fixation of distal humerus fractures: A finite element biomechanical study. J Hand Surg (Am), 2022, 47(7): 690.e1-690.e11.
23. Zdero R, Brzozowski P, Schemitsch EH. Biomechanical design optimization of distal humerus fracture plates: A review. Biomed Res Int, 2024, 2024: 6015794. doi: 10.1155/2024/6015794.
24. Penzkofer R, Hungerer S, Wipf F, et al. Anatomical plate configuration affects mechanical performance in distal humerus fractures. Clin Biomech (Bristol), 2010, 25(10): 972-978.
25. Got C, Shuck J, Biercevicz A, et al. Biomechanical comparison of parallel versus 90-90 plating of bicolumn distal humerus fractures with intra-articular comminution. J Hand Surg (Am), 2012, 37(12): 2512-2518.
26. Kudo T, Hara A, Iwase H, et al. Biomechanical properties of orthogonal plate configuration versus parallel plate configuration using the same locking plate system for intra-articular distal humeral fractures under radial or ulnar column axial load. Injury, 2016, 47(10): 2071-2076.
27. Druel T, Burnier M, Herzberg G. Long dorsal “Y-shaped” plate for distal diaphyseal humeral fractures. Int Orthop, 2021, 45(5): 1309-1314.
28. Bel JC. Pitfalls and limits of locking plates. Orthop Traumatol Surg Res, 2019, 105(1S): S103-S109.
29. Aguado HJ, Mingo-Robinet J, García-Virto V, et al. AO/OTA type C3 distal humeral fractures in patients aged 75 years and older: Is ORIF with double precontoured anatomical locking plates a reliable treatment? Injury, 2023, 54 Suppl 7: 111043. doi: 10.1016/j.injury.2023.111043.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesBiomechanical advantages of personalized Y-shaped plates in treatment of distal humeral intra-articular fractures

Abstract Full text Figures/Tables Video References Cited by

Format

Content