Proximal humeral fracture fixation: multicenter study with carbon fiber peek plate.

BACKGROUND: Locking plate fixation is a reliable treatment for many displaced proximal humeral fractures. Carbon fiber-reinforced-poly-ether-ether-ketone (CFR-PEEK) plates have recently been introduced as an alternative to traditional metallic plates. METHODS: In a multicenter study involving the Orthopedic Services of 6 Italian hospitals, 182 patients with a proximal humeral fracture were treated with a Diphos H (Lima Corporate, San Daniele del Friuli, Italy) CFR-PEEK plate, 160 of whom were followed clinically and radiographically for 2 years or more. Fractures were classified by Neer's system. The functional results were assessed by Constant and DASH scores. RESULTS: The average time to radiographic healing was 5.6 months in 158 of 160 cases. Mean Constant score was 76, and mean DASH score was 28 at 2 years. There were two nonunions (one septic and one aseptic) and 13 cases of partial (9) or massive (4) humeral head necrosis. In three of the 78 patients treated with the first-generation plates, hardware breakage happened during the operation and the plate was replaced. There was no failure among the cases treated with the thicker second-generation plate. In eight cases, there was a perforation of the humeral head by the cephalic screws. CONCLUSIONS: CFR-PEEK plates proved as reliable as metallic plates in the treatment of proximal humeral fractures. The advantages of these new devices include a better visualization of fracture reduction during intraoperative fluoroscopic assessment and easy hardware removal due to the absence of screw-plate cold fusion.

Reverse shoulder arthroplasty using a "L" shaped allograft for glenoid reconstruction in a patient with massive glenoid bone loss: case report.

Primary reverse total shoulder arthroplasty (RSA) has demonstrated to relieve pain, restore function and active elevation in patients with Cuff Tear Arthropathy. This condition of muscular imbalance could lead, in the long-term, to morphologic changes of the glenoid's anatomy. Insufficient bone stock of glenoid is a major challenge and without reconstruction, may be inadequate to support a glenoid component. Many authors have proposed the use of a bone graft in these cases and different techniques have been described to reconstruct severe bone loss of the glenoid but no ideal approach has currently been identified. We report the use of a "L" shaped frozen allograft for glenoid reconstruction in a patient with massive, uncontained glenoid bone loss, undergoing a reverse shoulder arthroplasty in a "one step" procedure. At 1-year follow-up both x-rays and CT showed graft incorporation with no resorption of bone and the patient reported continued stability of the shoulder and a high-level of satisfaction in terms of pain and function.