Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures

Abstract

Background: There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures.

Questions/purposes: The objective of this prospective observational study was to compare the clinical and radiologic outcomes of plate versus nail fixation of three-part proximal humeral fractures.

Patients and methods: Two hundred eleven patients with unstable three-part proximal humeral fractures were treated with ORIF using plate (PHILOS [proximal humeral interlocking system]/LPHP [locking proximal humerus plate]) or nail (PHN [proximal humeral nail]) osteosynthesis. Outcome measurements included pain, Constant and Murley and Neer scores, and the occurrence of complications at 3, 6, and 12 months postsurgery. Regression analysis and the likelihood ratio test were used to evaluate differences between the cohorts.

Results: Throughout the 1-year followup period the Constant and Murley scores improved significantly for both cohorts; there was no significant difference between the nail group compared with the plate group. Also, 1-year Neer scores were similar between the two cohorts. Patients in the PHN group perceived significantly less pain compared with patients in the plate fixation group at 3, 6 and 12 months after surgery. We observed 79 local complications in 60 patients with no significant risk difference between the treatment groups; 35 intraoperative complications were directly related to the initial surgical procedure.

Conclusions: The similar 1-year outcomes for nail versus plate fixation of three-part proximal humeral fractures suggest that both techniques may be useful for internal fixation of these fractures. Many complications were related to incorrect surgical technique and therefore can be avoided. Advanced surgical skills and experience are considered to be more critical for successful operative treatment of three-part proximal humeral fractures than the selection of the implant.

Level of evidence: Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

The box plot shows the absolute Constant and Murley scores for the plate and nail osteosynthesis treatment groups at the 3-, 6-, and 12-month followups.

Fig. 2

The box plot shows the surgical time taken for plate and nail osteosynthesis of three-part proximal humerus fractures. The ends of each rectangle correspond to the upper and lower quartiles of the data values. The line drawn through the rectangle corresponds to the median value. The whiskers, starting at the ends of the rectangle (or points representing extreme values), indicate minimum and maximum values.

Fig. 3

The box plot shows the categorized Neer scores for the plate and nail osteosynthesis treatment groups at 1 year.