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.
Michael Kimmeyer, Jonas Schmalzl, Verena Rentschler, Christian Schieffer, Arno Macken, Christian Gerhardt, Lars-Johannes Lehmann
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Abstract
Background: Plate osteosynthesis with implants made of carbon-fibre-reinforced polyetheretherketone (CFR-PEEK) has recently been introduced for the treatment of fractures of the proximal humerus (PHFs). The advantages of the CFR-PEEK plate are considered to be its radiolucency, its favourable modulus of elasticity, and the polyaxial placement of the screws with high variability of the angle. The primary aim of this study is to investigate the influence of calcar screw positioning on the complication and revision rates after CFR-PEEK plating of PHFs. The secondary aim is to assess its influence on functional outcome.
Material and methods: Patients were identified retrospectively. Minimum follow-up was 12 months. The cohort was divided into two groups depending on the distance of the calcar screw to the calcar (group I: < 12 mm, group II: ≥ 12 mm). The range of motion (ROM), Subjective Shoulder Value Score (SSV) and Constant-Murley Score (CS) were analysed at follow-up examination. Subjective complaints, complications (e.g. humeral head necrosis, varus dislocation) and the revision rate were evaluated.
Results: 51 patients (33 female, 18 male) with an average age of 68.6 years were included after a period of 26.6 months (group I: 32 patients, group II: 19 patients). Apart from the gender distribution, no significant differences were seen in the patient characteristics. The outcome scores showed significantly better clinical results in group I: SSV 83.4 vs 71.2, p = 0.007; CS 79.1 vs 67.8, p = 0.013. Complications were seen less frequently in group I (18.8 % vs 47.4 %, p = 0.030).
Conclusion: This study shows that the positioning of the calcar screw is relevant for CFR-PEEK plate osteosynthesis in PHFs with a good reduction of the fracture. Optimal positioning of the calcar screw close to the calcar (< 12 mm) is associated with a lower rate of complications, resulting in significantly superior functional outcomes.
Level of evidence: III, retrospective cohort study.
背景：碳纤维增强聚醚醚酮（CFR-PEEK）植入物的钢板接骨术最近被引入治疗肱骨近端骨折（PHF）。CFR-PEEK板的优点被认为是其射线透过性、良好的弹性模量以及螺钉的多轴放置，角度变化很大。本研究的主要目的是研究股骨距螺钉定位对PHF CFR-PEEK钢板术后并发症和翻修率的影响。次要目的是评估其对功能结果的影响。材料和方法：对患者进行回顾性鉴定。最低随访时间为12个月。根据股骨距螺钉到股骨距的距离，将队列分为两组（第一组：<12mm，第二组：≥12mm）。在随访检查中分析运动范围（ROM）、主观肩部价值评分（SSV）和恒定Murley评分（CS）。评估主观主诉、并发症（如肱骨头坏死、内翻脱位）和翻修率。结果：在26.6个月后纳入了51名患者（33名女性，18名男性），平均年龄68.6岁（第一组：32名患者，第二组：19名患者）。除了性别分布外，患者特征没有显著差异。结果评分显示I组的临床结果明显更好：SSV 83.4 vs 71.2，p=0.007；CS 79.1 vs 67.8，p=0.013。I组并发症发生率较低（18.8%vs 47.4%，p=0.030）。结论：本研究表明，股骨距螺钉的定位与CFR-PEEK钢板在PHFs中的接骨相关，骨折复位良好。股骨距螺钉靠近股骨距（<12mm）的最佳位置与较低的并发症发生率相关，从而产生显著优越的功能结果。证据水平：III，回顾性队列研究。
期刊介绍：
The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.
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