Functional results and unfavorable events after treatment of proximal humerus fractures using a new locking plate system

Abstract

Background Proximal humerus fractures are often treated with a fixed-angle titanium plate osteosynthesis. Recently, plates made of alternative materials such as carbon fibre-reinforced polyetheretherketone (CFR-PEEK) have been introduced. This study presents the postoperative results of patients treated with a CFR-PEEK plate. Methods Patients with proximal humerus fractures treated with a CFR-PEEK plate (PEEKPower™ Humeral Fracture Plate (HFP)) were included. In follow-up examination, age and gender adjusted Constant-Murley Score (ACS), Subjective Shoulder Value (SSV), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH) and pain score (Visual Analog Scale (VAS)) were analyzed. General condition at follow-up was measured by European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L). Range of motion was recorded. In addition, radiographs at follow-up, unfavorable events and revision rate were analyzed. Results In total, 98 patients (66.0 ± 13.2 years, 74 females, 24 males) were reexamined. Mean follow-up was 27.6 ± 13.2 months. There were 15 2-part, 28 3-part and 55 4-part fractures. The functional scores showed good results: SSV 83.3 ± 15.6%, QDASH 13.1 ± 17.0 and ACS 80.4 ± 16.0. A 4-part-fracture, head split component, nonanatomic head shaft reposition and preoperative radiological signs of osteoarthritis were significant negative predictors for poorer clinical scores. Unfavourable events were observed in 27 patients (27.6%). Revision surgery was performed in 8 (8.2%) patients. Risk factors for an unfavourable event were female gender, age of 50 years and older, diabetes, affected dominant hand, 4-part fracture, head split and preoperative radiological signs of osteoarthritis. Conclusion There are several advantages of the CFR-PEEK plate (PEEKPower™ Humeral Fracture Plate (HFP)) such as the polyaxial screw placement and higher stability of locking screws. In summary, the CFR-PEEK plate osteosynthesis is a good alternative with comparable clinical results and some biomechanical advantages. Proximal humerus fractures show good clinical results after treatment with a CFR-PEEK plate. The revision rate and the risk of unfavorable events are not increased compared to conventional titanium plate osteosynthesis. Level of evidence IV

Carbon-fibre plates for traumatic and (impending) pathological fracture fixation: Where do we stand? A systematic review

“…In the upper extremity, seven studies evaluated CF plate fixation after traumatic proximal humerus fractures, involving a total of 391 patients [ 16 , 26 – 31 ]. The most frequently reported complications were soft tissue complications ( n = 52; 13%), including impingement between plate and acromion ( n = 18), rotator cuff lesions ( n = 18), adhesive capsulitis/shoulder stiffness ( n = 15) and an intra-articular bicep tendon rupture ( n = 1).…”

“…New technologies are often associated with a learning curve, as performance tends to improve over time [ 52 , 53 ]. Nevertheless, the surgical procedure in terms of operation time and accuracy of implant position was similar in CF plates compared with metal plates [ 31 , 33 ]. Moreover, comparable rates of reported complications suggest that implementation of CF plates does not necessitate additional training.…”

Correct positioning of the calcar screw leads to superior results in proximal humerus fractures treated with carbon-fibre-reinforced polyetheretherketone plate osteosynthesis with polyaxial locking screws

“…PHFs are often treated with angular stable plate fixation [ 13 ]. Carbon-fibre-reinforced polyetheretherketone (CFR-PEEK) plates have recently been introduced as an alternative to the most commonly used titanium plates [ 11 , 19 , 23 , 30 ]. There are several biomechanical advantages of CFR-PEEK plates, such as higher stability of the locking screws, a favourable modulus of elasticity and no cold welding [ 10 , 24 ].…”