Introduction
The treatment of the fractures of the proximal humerus is controversial and there is a poor consensus especially for the three and
four-part fractures. The poor consensus concerns also the materials of fixation. We report the short-term follow-up of this kind of fractures treated by angular stable plate of Peek (Polyether ether ketone) fixed by titanium screws (Ti6AI4V).
Materials and methods
This non-randomized prospective study includes 10 patients with fractures of the proximal humerus and was started in December 2009. The average age was 70 years (range, 64–78). Of these, seven had 3-part fractures and three had 4-part fractures. Surgery was performed in the beach chair position using a delto-pectoral approach without detachment of the deltoid and an angular stable plate of Peek (DiPhos). Patient re-evaluation was performed following the constant score.
Results
The mean follow-up was of 10 months (range, 7–16).
The mean constant score was 68 and the maximum was 84. The average front elevation was 98 degrees and the average external rotation was 28 degrees. There were no infections, malunions or loss of reduction in any of the patients.
Union occurred in all patients at an average of seven to nine weeks postoperatively.
Discussion
Early results in osteosynthesis of fractures of the proximal humerus with plates of Peek are encouraging. The ease of implantation and the percentage of union have been similar to those obtained with titanium plates. Also the functional outcomes have been similar to those obtained with ostheosynthesis using the traditional angular stable plate of titanium. We also had the advantages provided by the new material. The hole in the fixed-angle plate in fact is not threaded, but the titanium screw taps the plate hole, thus it can be inserted in the desired direction. Furthermore, Peek is an inert material and so the galvanic corrosion between the plate and the screw head is absent: the removal of the implant is easier.
Finally, the radiolucency of the plate is useful in controlling intraoperative reduction of the fracture and at follow-up of the healing process.
Conclusions
Peek seems to be a very interesting material in osteosynthesis. However, due to the short follow-up and the small number of patients, the proceedings and the results must be considered provisional.
P. Budassi, MD, S. Stroppa, MD
Azienda Ospedaliera “Istituti Ospitalieri” di Cremona
Cremona (Italy)
