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Pegs not superior to screws for fixation of fractures of the proximal humerus

BACKGROUND: Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of adverse events and reoperations have been reported. One frequent reason is secondary penetration of screws into the gle...

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Autores principales: Bønes, Ingrid, Karlberg, Anna Cecilie, Liljeholm, Maria, Fraser, Alexander Nilsskog, Madsen, Jan Erik, Fjalestad, Tore
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812225/
https://www.ncbi.nlm.nih.gov/pubmed/35109905
http://dx.doi.org/10.1186/s13018-022-02947-3
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author Bønes, Ingrid
Karlberg, Anna Cecilie
Liljeholm, Maria
Fraser, Alexander Nilsskog
Madsen, Jan Erik
Fjalestad, Tore
author_facet Bønes, Ingrid
Karlberg, Anna Cecilie
Liljeholm, Maria
Fraser, Alexander Nilsskog
Madsen, Jan Erik
Fjalestad, Tore
author_sort Bønes, Ingrid
collection PubMed
description BACKGROUND: Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of adverse events and reoperations have been reported. One frequent reason is secondary penetration of screws into the glenohumeral joint, due to sinking of the fracture or avascular head necrosis. To prevent joint penetrations angular stable plates with smooth locking pegs instead of locking screws have been developed. The aim of the present study was to investigate whether blunt pegs instead of pointed screws reduced the risk of secondary penetration into the glenohumeral joint during fracture healing after operatively treated PHFs. METHODS: From two different patient cohorts with displaced PHFs (60 treated with PHILOS plate with screws and 50 with ALPS-PHP plate with pegs), two groups were matched according to fracture type AO/OTA 11-B2 and 11-C2 and age (55–85 years). They were followed up at 3, 6 and 12 months. Primary outcome was radiographic signs of peg or screw penetrations into the glenohumeral joint at 12 months. Secondary outcomes were Oxford shoulder score (OSS) and Constant Score (CS) and radiographic signs of avascular humeral head necrosis (AVN). RESULTS: Eighteen PHILOS patients with B2 and C2 fractures could be matched with a corresponding group of 18 operated with ALPS-PHP with pegs. The number of penetrations of pegs and screws were equal between the two groups and the development of avascular head necrosis did not differ either. The functional outcomes for both OSS and CS at 12 months was clearly in favor of patients without joint penetrations in both groups. CONCLUSION: We found no differences in the number of screw or peg penetrations in the PHILOS and ALPS-PHP group and the occurrence of AVN was equal. Joint penetrations led to inferior functional outcomes at 1 year. The ClinicalTrials.gov identifier 20/11/12 prospectively for the Philos Group is NCT01737060, and for the ALPS group 11/03/20 retrospectively is NCT04622852.
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spelling pubmed-88122252022-02-07 Pegs not superior to screws for fixation of fractures of the proximal humerus Bønes, Ingrid Karlberg, Anna Cecilie Liljeholm, Maria Fraser, Alexander Nilsskog Madsen, Jan Erik Fjalestad, Tore J Orthop Surg Res Research Article BACKGROUND: Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of adverse events and reoperations have been reported. One frequent reason is secondary penetration of screws into the glenohumeral joint, due to sinking of the fracture or avascular head necrosis. To prevent joint penetrations angular stable plates with smooth locking pegs instead of locking screws have been developed. The aim of the present study was to investigate whether blunt pegs instead of pointed screws reduced the risk of secondary penetration into the glenohumeral joint during fracture healing after operatively treated PHFs. METHODS: From two different patient cohorts with displaced PHFs (60 treated with PHILOS plate with screws and 50 with ALPS-PHP plate with pegs), two groups were matched according to fracture type AO/OTA 11-B2 and 11-C2 and age (55–85 years). They were followed up at 3, 6 and 12 months. Primary outcome was radiographic signs of peg or screw penetrations into the glenohumeral joint at 12 months. Secondary outcomes were Oxford shoulder score (OSS) and Constant Score (CS) and radiographic signs of avascular humeral head necrosis (AVN). RESULTS: Eighteen PHILOS patients with B2 and C2 fractures could be matched with a corresponding group of 18 operated with ALPS-PHP with pegs. The number of penetrations of pegs and screws were equal between the two groups and the development of avascular head necrosis did not differ either. The functional outcomes for both OSS and CS at 12 months was clearly in favor of patients without joint penetrations in both groups. CONCLUSION: We found no differences in the number of screw or peg penetrations in the PHILOS and ALPS-PHP group and the occurrence of AVN was equal. Joint penetrations led to inferior functional outcomes at 1 year. The ClinicalTrials.gov identifier 20/11/12 prospectively for the Philos Group is NCT01737060, and for the ALPS group 11/03/20 retrospectively is NCT04622852. BioMed Central 2022-02-02 /pmc/articles/PMC8812225/ /pubmed/35109905 http://dx.doi.org/10.1186/s13018-022-02947-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Bønes, Ingrid
Karlberg, Anna Cecilie
Liljeholm, Maria
Fraser, Alexander Nilsskog
Madsen, Jan Erik
Fjalestad, Tore
Pegs not superior to screws for fixation of fractures of the proximal humerus
title Pegs not superior to screws for fixation of fractures of the proximal humerus
title_full Pegs not superior to screws for fixation of fractures of the proximal humerus
title_fullStr Pegs not superior to screws for fixation of fractures of the proximal humerus
title_full_unstemmed Pegs not superior to screws for fixation of fractures of the proximal humerus
title_short Pegs not superior to screws for fixation of fractures of the proximal humerus
title_sort pegs not superior to screws for fixation of fractures of the proximal humerus
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812225/
https://www.ncbi.nlm.nih.gov/pubmed/35109905
http://dx.doi.org/10.1186/s13018-022-02947-3
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