Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2017 Nov 29:12:2047-2054.
doi: 10.2147/CIA.S144084. eCollection 2017.

Efficacy comparison of intramedullary nails, locking plates and conservative treatment for displaced proximal humeral fractures in the elderly

Wei Ge #  1 , Qi Sun #  1 , Gen Li  1 , Guanghua Lu  1 , Ming Cai  1 , ShaoHua Li  1
Affiliations
Clinical Trial

Efficacy comparison of intramedullary nails, locking plates and conservative treatment for displaced proximal humeral fractures in the elderly

Wei Ge et al. Clin Interv Aging. .

Abstract

Purpose: The incidence of proximal humeral fractures is high in the elderly, and the superior management of these fractures remains a controversy. The study aims to compare clinical outcomes of intramedullary nails, locking plates and conservative treatment for the management of displaced proximal humeral fractures in the elderly.

Patients and methods: In this prospective study, a total of 198 patients with 2- or 3-part proximal humeral fractures who received fixation of locking plates or intramedullary nails or conservative treatment were included. The primary outcome was the 24-month Constant-Murley score. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) scores, the visual analog scale (VAS) pain scores, shoulder range of motion and complication rate.

Results: There were no statistically significant differences in the Constant-Murley scores and ASES scores among the plate group, the nail group and the conservative group for 2-part fractures. For 3-part fractures, Constant-Murley scores and ASES scores were lower in the conservative group compared with those in the plate group and the nail group. Besides, the conservative group showed a significantly lower external rotation during follow-ups. The complication rate was comparable among the plate group, the nail group and the conservative group for both 2-part and 3-part fractures.

Conclusion: Similar satisfactory functional outcomes can be achieved with the locking plates, intramedullary nails or conservative treatment for 2-part proximal humeral fractures in the elderly. The advantages in functional outcomes favor locking plates and intramedullary nails in the management of 3-part proximal humeral fractures.

Keywords: conservative treatment; intramedullary nails; locking plates; proximal humeral fractures; the elderly.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of included patients in the study.
Figure 2
Figure 2
Clinical outcomes of locking plates, intramedullary nails and conservative treatment for 2-part proximal humeral fractures. Δ indicates significant differences between two values. Abbreviation: ASES, American Shoulder and Elbow Surgeons.
Figure 3
Figure 3
Clinical outcomes of locking plates, intramedullary nails and conservative treatment for 3-part proximal humeral fractures. Δ indicates significant differences between two values. Abbreviation: ASES, American Shoulder and Elbow Surgeons.
See this image and copyright information in PMC

References

    1. Hak DJ, Mauffrey C, Hake M, Hammerberg EM, Stahel PF. Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics. 2015;38(4):247–251. - PubMed
    1. Bahrs C, Stojicevic T, Blumenstock G, et al. Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures. Int Orthop. 2014;38(8):1697–1704. - PMC - PubMed
    1. Li Y, Zhao L, Zhu L, Li J, Chen A. Internal fixation versus nonoperative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials. PLoS One. 2013;8(9):e75464. - PMC - PubMed
    1. Maier D, Jäger M, Strohm PC, Südkamp NP. Treatment of proximal humeral fractures – a review of current concepts enlightened by basic principles. Acta Chir Orthop Traumatol Cech. 2012;79(4):307–316. - PubMed
    1. Hintermann B, Trouillier HH, Schafer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br. 2000;82(8):1107–1112. - PubMed