Comparison Between CFR-PEEK and Titanium Plate for Proximal Humeral Fracture: A Meta-analysis

Overview

Journal Jt Dis Relat Surg

Date 2024 Aug 27

PMID 39189556

Authors

Li-Ming Song

Gui-Xin Wang

Lei Wang

Affiliations

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Abstract

Objectives: The aim of the present meta-analysis was to compare the efficacy and safety of the carbon fiber-reinforced polyetheretherketone (CFR-PEEK) and titanium plate for the treatment of proximal humeral fractures (PHFs) from clinical comparative trials.

Materials And Methods: A comprehensive search of English databases was carried out, such as PubMed, Web of Science, ScienceDirect, Springer and Cochrane Library databases. The RevMan version 5.1 software was applied for statistical analysis, and the mean difference (MD) and risk difference (RD) as the combined variables, and "95%" as the confidence interval (CIs).

Results: One randomized-controlled trial and five retrospective controlled studies including 282 PHFs were considered eligible and finally included. Meta-analysis demonstrated that there were significant differences in Constant score (CS) (MD=9.23; 95% CI: 5.02, 13.44; p<0.0001), anterior elevation (MD=18.83; 95% CI: 6.27, 31.38; p=0.003), lateral elevation (MD=18.42; 95% CI: 3.64, 33.19; p=0.01) and adduction (MD=3.53; 95% CI: 0.22, 6.84; p=0.04). No significant differences were observed regarding Constant score compared to the contralateral shoulder, Oxford Shoulder Score, internal rotation, external rotation, screw perforation and cutout, varus/valgus malalignment, humeral head collapse/necrosis, implant removal, and revision surgery between the two groups.

Conclusion: Compared to titanium plate, CFR-PEEK plate showed better Constant score, anterior elevation, lateral elevation and adduction in treating PHFs. The complications are comparable to those achieved with conventional titanium plates.

References

Ding R, Chen T, Xu Q, Wei R, Feng B, Weng J . Mixed Modification of the Surface Microstructure and Chemical State of Polyetheretherketone to Improve Its Antimicrobial Activity, Hydrophilicity, Cell Adhesion, and Bone Integration. ACS Biomater Sci Eng. 2021; 6(2):842-851. DOI: 10.1021/acsbiomaterials.9b01148. View

Fleischhacker E, Sprecher C, Milz S, Saller M, Gleich J, Siebenburger G . Functional outcomes before and after implant removal in patients with posttraumatic shoulder stiffness and healed proximal humerus fractures: does implant material (PEEK vs. titanium) have an impact? - a pilot study. BMC Musculoskelet Disord. 2022; 23(1):95. PMC: 8796509. DOI: 10.1186/s12891-022-05061-x. View

Kirchhoff C, Braunstein V, Kirchhoff S, Sprecher C, Ockert B, Fischer F . Outcome analysis following removal of locking plate fixation of the proximal humerus. BMC Musculoskelet Disord. 2008; 9:138. PMC: 2569939. DOI: 10.1186/1471-2474-9-138. View

Handoll H, Gillespie W, Gillespie L, Madhok R . The Cochrane Collaboration: a leading role in producing reliable evidence to inform healthcare decisions in musculoskeletal trauma and disorders. Indian J Orthop. 2009; 42(3):247-51. PMC: 2739468. DOI: 10.4103/0019-5413.41849. View

Berkes M, Little M, Lorich D . Open reduction internal fixation of proximal humerus fractures. Curr Rev Musculoskelet Med. 2013; 6(1):47-56. PMC: 3702763. DOI: 10.1007/s12178-012-9150-y. View

Meier R, Messmer P, Regazzoni P, Rothfischer W, Gross T . Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate. J Orthop Trauma. 2006; 20(4):253-60. DOI: 10.1097/00005131-200604000-00004. View

Lorenz G, Schonthaler W, Huf W, Komjati M, Fialka C, Boesmueller S . Complication rate after operative treatment of three- and four-part fractures of the proximal humerus: locking plate osteosynthesis versus proximal humeral nail. Eur J Trauma Emerg Surg. 2020; 47(6):2055-2064. DOI: 10.1007/s00068-020-01380-7. View

Schliemann B, Seifert R, Theisen C, Gehweiler D, Wahnert D, Schulze M . PEEK versus titanium locking plates for proximal humerus fracture fixation: a comparative biomechanical study in two- and three-part fractures. Arch Orthop Trauma Surg. 2016; 137(1):63-71. DOI: 10.1007/s00402-016-2620-8. View

Palvanen M, Kannus P, Niemi S, Parkkari J . Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006; 442:87-92. DOI: 10.1097/01.blo.0000194672.79634.78. View

10.

Katthagen J, Schwarze M, Warnhoff M, Voigt C, Hurschler C, Lill H . Influence of plate material and screw design on stiffness and ultimate load of locked plating in osteoporotic proximal humeral fractures. Injury. 2016; 47(3):617-24. DOI: 10.1016/j.injury.2016.01.004. View

11.

Katthagen J, Ellwein A, Lutz O, Voigt C, Lill H . Outcomes of proximal humeral fracture fixation with locked CFR-PEEK plating. Eur J Orthop Surg Traumatol. 2016; 27(3):351-358. DOI: 10.1007/s00590-016-1891-7. View

12.

Cvetanovich G, Gowd A, Liu J, Nwachukwu B, Cabarcas B, Cole B . Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2019; 28(5):939-948. DOI: 10.1016/j.jse.2018.10.013. View

13.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J . Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73(9):712-6. DOI: 10.1046/j.1445-2197.2003.02748.x. View

14.

Dey Hazra R, Szewczyk K, Ellwein A, Blach R, Jensen G, Kuhnapfel A . Minimum 2-year results of the second-generation CFR-PEEK locking plate on the proximal humeral fracture. Eur J Orthop Surg Traumatol. 2022; 33(4):1307-1314. DOI: 10.1007/s00590-022-03298-9. View

15.

Padolino A, Porcellini G, Guollo B, Fabbri E, Kiran Kumar G, Paladini P . Comparison of CFR-PEEK and conventional titanium locking plates for proximal humeral fractures: a retrospective controlled study of patient outcomes. Musculoskelet Surg. 2018; 102(Suppl 1):49-56. DOI: 10.1007/s12306-018-0562-8. View

16.

Beeres F, Hallensleben N, Rhemrev S, Goslings J, Oehme F, Meylaerts S . Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications. Arch Orthop Trauma Surg. 2017; 137(12):1685-1692. DOI: 10.1007/s00402-017-2790-z. View

17.

Rotini R, Cavaciocchi M, Fabbri D, Bettelli G, Catani F, Campochiaro G . Proximal humeral fracture fixation: multicenter study with carbon fiber peek plate. Musculoskelet Surg. 2015; 99 Suppl 1:S1-8. DOI: 10.1007/s12306-015-0371-2. View

18.

Mugnai R, Tarallo L, Capra F, Catani F . Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures. Orthop Traumatol Surg Res. 2018; 104(6):877-882. DOI: 10.1016/j.otsr.2018.05.002. View

19.

Schliemann B, Hartensuer R, Koch T, Theisen C, Raschke M, Kosters C . 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 Elbow Surg. 2015; 24(8):1282-8. DOI: 10.1016/j.jse.2014.12.028. View

20.

Pavone V, Vescio A, Denaro R, Costa D, Condorelli G, Caruso V . Use of different devices for surgical treatment of proximal humerus fractures in adults: a systematic review. Acta Biomed. 2021; 92(4):e2021198. PMC: 8477127. DOI: 10.23750/abm.v92i4.11394. View