Please login to view this media
- Talk
- 21/09/2021
- UK
Does the Addition of Cross-element Fixation Prevent Locking Screw Subsidence following Plate Fixation of Proximal Humerus Fractures?
Description
This presented study by Priyadarshi Amit, a clinical fellow at Royal London Hospital, addresses relevant complications post proximal humerus fracture fixation, focusing specifically on the effectiveness of cross-elements in reducing screw subsidence. The paper outlines the concerning rates of screw-related complications associated with traditional locking plates, where complications can range from 11% to 40%. Notably, screw penetration is identified as the most prevalent issue, contributing to approximately 80% of complications, which includes screw pull-out and cut-outs.
The research highlights that conventional locking screws can experience subsidence due to humeral head impaction early in the healing process. Subsequently, the introduction of cross-elements in the Pantera plate system demonstrates a biomechanical advantage in resisting displacement and sustaining loads compared to standard locking screws, yet clinical evidence remained limited.
The study included patients with Neer’s two, three, or four-part fractures, excluding those treated with intramedullary nailing or suture fixation. Participants were divided into two groups based on the type of fixation used: cross-elements and conventional locking plates. The screw subsidence index (SSI) was developed to quantify subsidence, measuring the head ratio of the screws pre and post-operatively.
Results indicated no screw subsidence in the cross-element group, contrasting with an observable increase in the screw head ratio in the conventional group, ultimately leading to significant differences in SSI values between groups. Additionally, complications arose more frequently in the conventional group, including cases of avascular necrosis, necessitating a reversal arthroplasty.
The findings advocate for the continued investigation of cross-elements in larger randomized controlled trials to solidify their role in preventing screw penetration and related complications in proximal humeral fracture fixation. The dialogue that followed the presentation involved probing necessary questions from audience members, discussing the clinical implications, surgical techniques, and outcomes related to fixation methods.