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Comparative Study
. 2009 Nov;467(11):2986-93.
doi: 10.1007/s11999-009-0916-5. Epub 2009 Jun 13.

Is locking nailing of humeral head fractures superior to locking plate fixation?

G Gradl  1 , A Dietze, M Kääb, W Hopfenmüller, T Mittlmeier
Affiliations
Comparative Study

Is locking nailing of humeral head fractures superior to locking plate fixation?

G Gradl et al. Clin Orthop Relat Res. 2009 Nov.

Abstract

The optimal surgical treatment of displaced proximal humeral fractures is controversial. New implants providing angular stability have been introduced to maintain the intraoperative reduction. In a multi-institutional study, we prospectively enrolled and followed 152 patients with unilateral displaced and unstable proximal humeral fractures treated either with an antegrade angular and sliding stable proximal interlocking nail or an angular stable plate. Fractures were classified according to the Neer four-segment classification. Clinical, functional, and radiographic followups were performed 3, 6, and 12 months after surgery. Absolute and relative (to the contralateral shoulder) Constant-Murley scores were used to assess postoperative shoulder function. Using age, gender, and fracture type, we identified 76 pairs (152 patients) for a matched-pairs analysis. Relative Constant-Murley scores 12 months after treatment with an angular and sliding stable nail and after plate fixation were 81% and 77%, respectively. We observed no differences between the two groups. Stabilization of displaced proximal humeral fractures with either an angular stable intramedullary or an extramedullary implant seems suitable with both surgical treatment options.

Level of evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1A–B
Fig. 1A–B
(A) A preoperative AP radiograph shows the shoulder of an 86-year-old female patient with a three-part fracture of the proximal humerus. (B) A postoperative AP radiograph shows the patient’s shoulder after Targon® PH nailing.
Fig. 2A–B
Fig. 2A–B
(A) A preoperative AP radiograph shows the shoulder of a 35-year-old male patient with a four-part fracture of the proximal humerus. (B) A postoperative AP radiograph shows the patient’s shoulder with LPHP fixation.
See this image and copyright information in PMC

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