T2.3 Is the peg better than the screw in the locking plates preventing penetration in proximal humeral fractures?

Abstract

Introduction: Surgical treatment outcome of PHiLOS and S3 plates in the same AO type proximal humerus fracture were compared. Materials and Methods: We evaluated the results of proximal humerus fractures in 15 patients treated with S3 plate, with a mean age of 64.5 (33–84) and a mean follow-up of 46.5 months (40.5– 52.5) and 15 patients with the same AO type fractures with a mean age of 66.8 (34–87) and a mean follow up of 68.4 (50.5–88) months between October 2005 and December 2012. Four patients in S3 plate group and one patient in PHiLOS group had rotator cuff repairs and we used cannulated screws for head fragments in three patients in S3 group and two patients in PHiLOS group. Results: We encountered postoperative complications in 4 (3 females, 1 male) patients in S3 group including three intraarticular peg penetrations, three head collapse, and one insufficient tubercule reductions. One patient with varus malposition had varus displacement and peg penetration. Two valgus impacted fractures postoperatively had peg penetrations due to head collapse at followups. In patients treatedwith PHiLOS plates, two insufficient tubercule reductions and two impingement syndromes were observed, screw penetration was not observed. Non of the patients had union problems. Constant–Murley scores are 80.5 (50–100) in S3 group and 86.2 (66–100) in PHiLOS group. Conclusion: When PHiLOS and S3 plate fixation was compared, complication rate of S3 plate fixation was higher. Design features acclaimed to prevent head penetration such as smooth pegs and subchondral support was not observed in clinical application of S3 plate in this cohort of patients with the same fracture types. We recommend cautious use of S3 plates especially in valgus impacted fractures.