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.

Keywords: Adverse event; Angle-stable osteosynthesis; Open reduction internal fixation; Polyetheretherketone; Proximal humerus fractures.

Fig. 1

Patient at follow-up after proximal humerus fracture. Testing the range of motion of an 87-year-old female patient at follow-up 3.5 years after a 3-part proximal humerus fracture of the right side treated with CFR-PEEK plate osteosynthesis: a) forward flexion, b) internal rotation, c) external rotation. (CFR-PEEK = carbon fibre-reinforced polyetheretherketone)

Fig. 2

Radiological measurements. Postoperative radiological measurements: radiographs in ap view with a) neck shaft angulation, b) head shaft distance (ap = anteroposterior)

Fig. 3

Radiological imaging of a 3-part proximal humerus fracture 69-year-old female patient with 3-part proximal humerus fracture treated with CFR-PEEK plate osteosynthesis; preoperative imaging: a) radiograph in ap view, b) CT scan in coronal plane, c) CT scan in sagittal plane; d) postoperative radiograph in lateral view. (CFR-PEEK = carbon fibre-reinforced polyetheretherketone, CT = computed tomography)