Validated computational framework for efficient systematic evaluation of osteoporotic fracture fixation in the proximal humerus

The high rate of fixation failure in osteoporotic proximal humerus fractures indicate the need for improved solutions. Computer simulations may help to overcome the limitations of the gold standard biomechanical testing in evaluating the performance of new implants and enhance the effectivity and outcome of the design process. This study presents a framework for automated computational analysis that facilitates efficient and systematic evaluation of proximal humerus fracture plating under a variety of conditions including bone quality, fracture pattern, implant configuration and loading regime. The underlying finite element methodology was previously validated. The capabilities of the software tool are demonstrated by virtually reproducing a previously published biomechanical study on the effect of screw augmentation and showing that the models capture the essence of the experimental results. Due to the modular design of the framework, the currently available set of angle-stable plate implants can be readily expanded to include other fixations such as intramedullary nails. Besides the capability to compare already existing solutions, the tool can provide rapid feedback on novel ideas. Therefore, it is expected to efficiently complement and partially replace expensive experimental tests and aid development and optimization of implant designs for improved fixation of osteoporotic proximal humerus fractures.