Does the Addition of Locked Cross-Elements Prevent Screw Subsidence Following Locking Plate Fixation of Proximal Humerus Fractures?

Purpose To compare screw subsidence and screw penetration in proximal humerus fracture fixation using the PANTERA plate with cross-elements (Toby Orthopaedics, Miami, FL, USA) versus the conventional PHILOS plate (Synthes, West Chester, PA, USA). Methods Twenty-seven patients treated with the PANTERA plate (cross-element group) were matched by age, gender, and injury side with sixty patients treated using the PHILOS plate (conventional group). Intraoperative and post-operative radiographs were analysed for humeral head subsidence (HHS), defined as the change in corrected distance from the screw tip to the articular surface along the screw axis, measured on coronal (Cor-HHS) and axial (Ax-HHS) views. Results The mean patient age was 55.03 ± 18.57 years, with similar gender distribution and fracture patterns between groups. Mean coronal HHS was lower in the cross-element group than in the conventional group, although the difference was not statistically significant (1.07 ± 2.29 mm versus 2.11 ± 2.64 mm, p=0.096). Axial HHS was similar between the groups (0.89 ± 3.93 mm versus 0.75 ± 3.34 mm, p=0.863). Conclusion The use of cross-elements in the PANTERA plate may reduce humeral head subsidence compared to a conventional plate system, potentially lowering the risk of screw penetration through the articular surface in proximal humerus fracture fixation.