Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year results of a prospective study and comparison to fixation with a conventional locking plate

Introduction:Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly.Methods:A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years.Results:The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty.Discussion:Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis.Conclusion:A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process.

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“… 63 A 2-year follow-up study using the radiolucent carbon fiber-reinforced polyetheretherketone plate reported a mean constant score of 71.3. 64 …”

Section: Managementmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

153

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“…The results of screening and application of inclusion/exclusion criteria are outlined in Figure 1 . 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 …”

Section: Resultsmentioning

confidence: 99%

Complications Associated with Locking Plate of Proximal Humerus Fractures

Kavuri

Bowden

Kumar

et al. 2018

IJOO

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“…However, film dosimetry has been well explored and established for mapping radiation dosage with appropriate spatial resolution and should have an imprecision of less than 4%. [12][13][14]. Moreover, the films have been normalized by peripheral reference measurements, which further reduces the risk of false measurements.…”

Section: Discussionmentioning

confidence: 99%

Carbon Fiber/Polyether Ether Ketone (CF/PEEK) Implants Allow for More Effective Radiation in Long Bones

et al. 2020

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Background: Metallic implants show dose-modulating effects in radiotherapy and complicate its computed tomography (CT)-based planning. Dose deviations might not only affect the surrounding tissues due to backscattering and inadvertent dose increase but might also compromise the therapeutic effect to the target lesion due to beam attenuation. Later on, follow-up imaging is often obscured by metallic artefacts. Purposes: This study investigates the dosimetric impact of titanium and radiolucent carbon fiber/polyether ether ketone (CF/PEEK) implants during adjuvant radiation therapy in long bones. (1) Does the use of CF/PEEK implants allow for a more homogenous application of radiation? (2) Is the dose delivery to the target volume more efficient when using CF/PEEK implants? (3) Do CF/PEEK implants facilitate CT-based radiation therapy planning? Materials and methods: After CT-based planning, bone models of six ovine femora were irradiated within a water phantom in two immersion depths to simulate different soft-tissue envelopes. Plates and intramedullary nails of both titanium and CF/PEEK were investigated. Radiation dosage and distribution patterns were mapped using dosimetry films. Results: First, the planned implant-related beam attenuation was lower for the CF/PEEK plate (1% vs. 5%) and the CF/PEEK nail (2% vs. 9%) than for corresponding titanium implants. Secondly, the effective decrease of radiation dosage behind the implants was noticeably smaller when using CF/PEEK implants. The radiation dose was not significantly affected by the amount of surrounding soft tissues. A significant imaging artefact reduction was seen in all CF/PEEK models. Conclusion: CF/PEEK implants lead to a more reliable and more effective delivery of radiation dose to an osseous target volume. With regard to radiation therapy, the use of CF/PEEK implants appears to be particularly beneficial for intramedullary nails.

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Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year results of a prospective study and comparison to fixation with a conventional locking plate

Cited by 58 publications

References 38 publications

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Complications Associated with Locking Plate of Proximal Humerus Fractures

Carbon Fiber/Polyether Ether Ketone (CF/PEEK) Implants Allow for More Effective Radiation in Long Bones

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