Computer simulation of humeral shaft fracture in throwing

Hypothesis: Throwing fractures of the humerus are well known, but the exact mechanism of injury is not clear. It has been postulated that these may be stress fractures because the forces have not seemed sufficient to cause acute fractures while throwing. Materials and methods: Using finite element analysis, we reproduced fractures of the humerus using 3-dimensional models built from computed tomography images of 5 healthy volunteers. To apply the load during throwing, we assumed that the humeral head was completely fixed, and external rotation torque was applied to the distal end of the humerus until the stress of the bone elements became greater than yield stress. We reproduced the fracture line by removing the bone elements. Results: The maximum stress concentration was seen in the distal shaft, where a typical spiral fracture was created in all cases. In the humeral models, the torque required to initiate fracture ranged from 51 to 70 Nm. A strong correlation existed between the torque required to initiate fracture and thickness of the humeral cortical bone (R² = 0.74). Conclusion: These results indicate that thickness of the humerus represents one factor contributing to fractures that occur while throwing. Level of evidence: Basic science study.