Effect of screw thread length on stiffness of proximal humerus locking plate constructs: A finite element study

Plate-based treatment of proximal humerus fractures is associated with a high risk of complications such as screw perforation into glenohumeral joint. Smooth and threaded pegs were developed with the hope of minimising these risks. No consensus exists onto which threading profile achieves stiffest bone-plate construct. This study investigated the biomechanical effect of five percentages of threading on individual humeral head screws on a bone-plate construct. A finite element model simulating a two-part proximal humerus fracture treated with a Spatial Subchondral Support plate was developed and validated against in vitro biomechanical tests. The proportion of the humeral head screw length that was threaded was varied between 0%-100% in 25% increments. A 5-mm cantilever varus displacement was applied and the required load (F5) was calculated. Full (100%) threading achieved the stiffest construct for all six screws. Fully threading all smooth pegs at once increased F5 by 18%. Threading did not increase F5 equally in all screws. Inferior three plate screws exhibited a larger increase in stiffness than superior three. Most of the mechanical benefits of threading in inferior three screws can be achieved by using threaded pegs (50% threading) while the superior three screws need to be fully threaded. In practice, the smooth surface profile may also offer additional mechanical benefits if implanted with longer lengths and larger diameters. Threading is an effective way of increasing the varus bending stiffness of proximal humerus plates constructs.