Skip to main content
SpringerLink
Log in

Comparison of CFR-PEEK and conventional titanium locking plates for proximal humeral fractures: a retrospective controlled study of patient outcomes

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Background

Metal plates are the fixation devices used most frequently to proximal humeral fractures (PHFs). However, in recent years carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plates have become increasingly common. This study compares the clinical and radiographic outcomes of 42 Neer three- and four-part PHFs treated with CFR-PEEK or metal (titanium) plates.

Materials and methods

Forty-two PHF patients were managed with CFR-PEEK plates (n = 21, males/females 9/12; mean age 57.4 years; mean follow-up 30.7 months; CFR-PEEK group) or metal plates (n = 21; males/females 7/14; mean age 55.8 years; mean follow-up 52.7 months; Metal group). Active shoulder mobility (anterior elevation, lateral elevation, external rotation, and internal rotation), the Constant–Murley Score, the Simple Shoulder Test Score, and the pain score were recorded. Preoperative computed tomography scans and X-rays were obtained. Postoperative fracture healing and displacement, tuberosity resorption and/or malposition, hardware position, and cortical thinning (CT) under the plate were assessed radiographically.

Results

Shoulder mobility, clinical, and pain scores were similar in both patient groups. CT was significantly greater in CFR-PEEK patients (mean difference, 1.14 mm; p = 0.0003). In both groups, incomplete or poor calcar reduction was associated to a significantly higher complication rate, especially stiffness and muscle weakness (p = 0.016). The rate of tuberosity resorption was significantly higher in the Metal group (p = 0.040). Two patients required revision to a hemiarthroplasty (CFR-PEEK) and reverse arthroplasty (Metal group).

Conclusions

CFR-PEEK plates provide a viable alternative to conventional titanium plates in PHFs, ensuring similar clinical outcomes and a lower rate of tuberosity resorption, but they involve higher stress shielding under the plate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Launonen AP, Lepola V, Saranko A, Flinkkilä T, Laitinen M, Mattila VM (2015) Epidemiology of proximal humerus fractures. Arch Osteoporos 10:209. https://doi.org/10.1007/s11657-015-0209-4

    Article  PubMed  Google Scholar 

  2. Passaretti D, Candela V, Sessa P, Gumina S (2017) Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elb Surg 26:2117–2124. https://doi.org/10.1016/j.jse.2017.05.029

    Article  Google Scholar 

  3. Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C et al (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 98:715–719. https://doi.org/10.1016/j.otsr.2012.05.013

    Article  CAS  PubMed  Google Scholar 

  4. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92

    Article  Google Scholar 

  5. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371

    Article  CAS  Google Scholar 

  6. Lee SH, Dargent-Molina P, Br_eart G (2002) Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 17:817–825. https://doi.org/10.1359/jbmr.2002.17.5.817

    Article  PubMed  Google Scholar 

  7. Neer CN (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Jt Surg Am 52:1077–1089

    Article  Google Scholar 

  8. Gaebler C, McQueen MM, Court-Brown CM (2003) Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand 74:580–585. https://doi.org/10.1080/00016470310017992

    Article  PubMed  Google Scholar 

  9. Handoll HH, Gibson JN, Madhok R (2003) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd000434

    Article  PubMed  Google Scholar 

  10. Schumaier A, Grawe B (2018) Proximal Humerus fractures: evaluation and management in the elderly patient. Geriatr Orthop Surg Rehabil 9:1–11. https://doi.org/10.1177/2151458517750516

    Article  Google Scholar 

  11. Zhao W, Zhang Y, Johansson D, Chen X, Zheng F, Li L (2017) Comparison of minimally invasive percutaneous plate osteosynthesis and open reduction internal fixation on proximal humeral fracture in elder patients: a systematic review and meta analysis. Biomed Res Int. https://doi.org/10.1155/2017/3431609

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sproul RC, Iyengar JJ, Devcic Z, Feeley BT (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42:408–413. https://doi.org/10.1016/j.injury.2010.11.058

    Article  PubMed  Google Scholar 

  13. Laux CJ, Grubhofer F, Werner CML, Simmen HP, Osterhoff G (2017) Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res 12:137. https://doi.org/10.1186/s13018-017-0639-3

    Article  PubMed  PubMed Central  Google Scholar 

  14. Huttunen TT, Launonen AP, Pihlajamäki H, Kannus P, Mattila VM (2012) Trends in the surgical treatment of proximal humeral fractures—a nationwide 23-year study in Finland. BMC Musculoskelet Disord 13:261. https://doi.org/10.1186/1471-2474-13-261

    Article  PubMed  PubMed Central  Google Scholar 

  15. Spross C, Zeledon R, Zdravkovic V, Jost B (2017) How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction-internal fixation of proximal humeral fractures. J Shoulder Elb Surg 26:1566–1572. https://doi.org/10.1016/j.jse.2017.02.026

    Article  Google Scholar 

  16. Giannotti S, Bottai V, Dell’osso G, Donati D, Bugelli G, De Paola S et al (2012) Indices of risk assessment of fracture of the proximal humerus. Clin Cases Miner Bone Metab 9:37–39

    PubMed  PubMed Central  Google Scholar 

  17. Gregory TM, Vandenbussche E, Augereau B (2013) Surgical treatment of three and four-part proximal humeral fractures. Orthop Traumatol Surg Res 99:S197–S207. https://doi.org/10.1016/j.otsr.2012.12.006

    Article  CAS  PubMed  Google Scholar 

  18. Dilisio MF, Nowinski RJ, Hatzidakis AM, Fehringer EV (2016) Intramedullary nailing of the proximal humerus: evolution, technique, and results. J Shoulder Elb Surg 25:e130–e138. https://doi.org/10.1016/j.jse.2015.11.016

    Article  Google Scholar 

  19. Schumer RA, Muckley KL, Markert RJ, Prayson MJ, Heflin J, Konstantakos EK et al (2010) Biomechanical comparison of a proximal humeral locking plate using two methods of head fixation. J Shoulder Elb Surg 19:495–501. https://doi.org/10.1016/j.jse.2009.11.003

    Article  Google Scholar 

  20. Yamamoto N, Hongo N, Berglund L, Sperling J, Cofield R, An K (2013) Biomechanical analysis of a novel locking plate with smooth pegs versus a conventional locking plate with threaded screws for proximal humerus fractures. J Shoulder Elb Surg 22:445–450. https://doi.org/10.1016/j.jse.2012.04.005

    Article  Google Scholar 

  21. Katthagen JC, Schwarze M, Warnhoff M, Voigt C, Hurschler C, Lill H (2016) Influence of plate material and screw design on stiffness and ultimate load of locked platingin osteoporotic proximal humeral fractures. Injury 47:617–624. https://doi.org/10.1016/j.injury.2016.01.004

    Article  PubMed  Google Scholar 

  22. Katthagen JC, Ellwein A, Lutz O, Voigt C, Lill H (2017) Outcomes of proximal humeral fracture fixation with locked CFR-PEEK plating. Eur J Orthop Surg Traumatol 27:351–358. https://doi.org/10.1007/s00590-016-1891-7

    Article  PubMed  Google Scholar 

  23. Feerick EM, Kennedy J, Mullett H, FitzPatrick D, McGarry P (2013) Investigation of metallic and carbon fibre PEEK fracture fixation devices for three part proximal humeral fractures. Med Eng Phys 35:712–722. https://doi.org/10.1016/j.medengphy.2012.07.016

    Article  PubMed  Google Scholar 

  24. Steinberg EL, Rath E, Shlaifer A, Chechik O, Maman E, Salai M (2013) Carbon fiber reinforced PEEK Optima:composite material biomechanical properties and wear/debris characteristics of CF PEEK composites for orthopedic trauma implants. J Mech Behav Biomed Mater 17:221–228. https://doi.org/10.1016/j.jmbbm.2012.09.013

    Article  CAS  PubMed  Google Scholar 

  25. Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF (2010) Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elb Surg 19:489–494. https://doi.org/10.1016/j.jse.2009.09.005

    Article  Google Scholar 

  26. Boileau P, Krishnan S, Tinsi L, Walch G, Coste J, Mole D (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elb Surg 11:401–412

    Article  CAS  Google Scholar 

  27. Spross C, Kaestle N, Benninger E, Fornaro J, Erhardt JB, Zdravkovic V et al (2015) Deltoid tuberosity index: a simple radiographic tool to assess local bone quality in proximal humerus fractures. Clin Orthop Relat Res 473:3038–3045. https://doi.org/10.1007/s11999-015-4322-x

    Article  PubMed  PubMed Central  Google Scholar 

  28. Helmy N, Hintermann B (2006) New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res 442:100–108

    Article  Google Scholar 

  29. Plecko M, Kraus A (2005) Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol 17:25–50

    Article  Google Scholar 

  30. Voigt C, Geisler A, Hepp P, Schulz AP, Lill H (2011) Are polyaxially locked screws advantageous in the plate osteosynthesis of proximal humeral fractures in the elderly? A prospective randomized clinical observational study. J Orthop Trauma 25:596–602. https://doi.org/10.1097/BOT.0b013e318206eb46

    Article  PubMed  Google Scholar 

  31. Walsh S, Reindl R, Harvey E, Berry G, Beckman L, Steffen T (2006) Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech 21:1027–1031

    Article  Google Scholar 

  32. Akeson WH, Woo SLY, Rutherford L, Coutts RD, Gonsalves M, Amiel D (1976) The effects of rigidity of internal fixation plates on long bone remodeling. Acta Orthop Scand 47:241–249

    Article  CAS  Google Scholar 

  33. Uhthoff HK, Bardos DI, Liskova-Kiar M (1981) The advantages of titanium alloy over stainless steel plates for the internal fixation of fractures: an experimental study in dogs. J Bone Jt Surg Br 63:427–434

    Article  Google Scholar 

  34. Uhthoff HK, Dubuc FL (1971) Bone structure changes in the dog under rigid internal fixation. Clin Orthop 81:165–170

    Article  CAS  Google Scholar 

  35. Uhthoff HK, Finnegan M (1983) The effects of metal plates on posttraumatic remodelling and bone mass. J Bone Jt Surg Br 65:66–71

    Article  CAS  Google Scholar 

  36. Perren SM, Cordey J, Rahn BA, Gautier E, Schneider E (1988) Early temporary porosis of bone induced by internal fixation implants: A reaction to necrosis, not to stress protection? Clin Orthop 232:139–151

    Google Scholar 

  37. Beeres FJP, Hallensleben NDL, Rhemrev SJ, Goslings JC, Oehme F, Meylaerts SAG (2017) Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications. Arch Orthop Trauma Surg 137:1685–1692. https://doi.org/10.1007/s00402-017-2790-z

    Article  PubMed  Google Scholar 

  38. Brorson S, Frich LH, Winther A, Hróbjartsson A (2011) Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus. Acta Orthop 82:475–481. https://doi.org/10.3109/17453674.2011.588856

    Article  PubMed  PubMed Central  Google Scholar 

  39. Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23:163–172. https://doi.org/10.1097/BOT.0b013e3181920e5b

    Article  PubMed  Google Scholar 

  40. Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elb Surg 18:837–844. https://doi.org/10.1016/j.jse.2009.06.004

    Article  Google Scholar 

  41. Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elb Surg 13:427–433

    Article  CAS  Google Scholar 

  42. Hirschmann MT, Fallegger B, Amsler F, Regazzoni P, Gross T (2011) Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma 25:286–293. https://doi.org/10.1097/BOT.0b013e3181f2b20e

    Article  PubMed  Google Scholar 

  43. Ockert B, Siebenbürger G, Kettler M, Braunstein V, Mutschler W (2014) Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus. J Shoulder Elb Surg 23:1223–1231. https://doi.org/10.1016/j.jse.2013.11.009

    Article  Google Scholar 

  44. Rotini R, Cavaciocchi M, Fabbri D, Bettelli G, Catani F, Campochiaro G et al (2015) Proximal humeral fracture fixation: multicenter study with carbon fiber peek plate. Musculoskelet Surg. https://doi.org/10.1007/s12306-015-0371-2

    Article  PubMed  Google Scholar 

  45. Schliemann B, Seifert R, Theisen C, Gehweiler D, Wähnert D, Schulze M et al (2017) PEEK versus titanium locking plates for proximal humerus fracture fixation: a comparative biomechanical study in two- and three-part fractures. Arch Orthop Trauma Surg 137:63–71. https://doi.org/10.1007/s00402-016-2620-8

    Article  PubMed  Google Scholar 

  46. Schliemann B, Hartensuer R, Koch T, Theisen C, Raschke MJ, Kösters C et al (2015) 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. J Shoulder Elb Surg 24:1282–1288. https://doi.org/10.1016/j.jse.2014.12.028

    Article  Google Scholar 

  47. Li Y, Zhao L, Zhu L, Li J, Chen A (2013) Internal fixation versus nonoperative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials. PLoS ONE 8:e75464. https://doi.org/10.1371/journal.pone.0075464

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elb Surg 20:747–755. https://doi.org/10.1016/j.jse.2010.12.018

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL della Romagna, Ambito Territoriale di Rimini, Cattolica, Italy

    A. Padolino, G. Porcellini, B. Guollo, G. N. Kiran Kumar, P. Paladini & G. Merolla

  2. Research and Innovation Department - AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy

    E. Fabbri

  3. Biomechanics Laboratory, Cervesi Hospital, Cattolica - AUSL della Romagna, Ambito Territoriale di Rimini, Cattolica, Italy

    G. Merolla

Authors
  1. A. Padolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Porcellini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Guollo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Fabbri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. N. Kiran Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Paladini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Merolla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Merolla.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human partecipants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual partecipants involved in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Padolino, A., Porcellini, G., Guollo, B. et al. Comparison of CFR-PEEK and conventional titanium locking plates for proximal humeral fractures: a retrospective controlled study of patient outcomes. Musculoskelet Surg 102 (Suppl 1), 49–56 (2018). https://doi.org/10.1007/s12306-018-0562-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-018-0562-8

Keywords

Search

Navigation