Fluoroscopic Evaluation of Reduction and Plate Positioning in Proximal Humerus Fractures: A Case-Control Study Comparing CFR-PEEK and Metallic Plates.

Objectives: Proximal humeral fractures (PHF) are common upper extremity injuries, particularly in older adults. Recently, carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plates have gained popularity in trauma surgery due to their bone-like elasticity, radiolucency, and reduced risk of stress shielding. However, their impact on intraoperative fracture reduction and implant positioning remains unclear. The aim of our study was to assess CFR-PEEK plates' impact on intraoperative fracture reduction and device positioning. Methods: This retrospective case-control study evaluated PHFs treated with CFR-PEEK plates versus conventional metallic plates. Radiologic parameters, including plate-tuberosity distance, tuberosity-head distance, neck-shaft angle, neck-shaft distance, head-shaft angle, were assessed postoperatively. Thirty patients with CFR-PEEK plates were matched with a metal plate control group based on age, gender, and fracture type. Results: The results showed no significant differences in fracture reduction quality between the two groups, suggesting CFR-PEEK plates allow comparable anatomical restoration. However, due to radiolucency and marker positioning, CFR-PEEK plates were more frequently placed too high. Conclusion: In conclusion, CFR-PEEK plates provide effective fracture fixation comparable to metal plates but require careful positioning to avoid complications. Surgeons should take extra precautions to ensure proper plate positioning, using intraoperative guides rather than freehand techniques.