Locking plate fixation versus intramedullary nail fixation for the treatment of multifragmentary proximal humerus fractures (OTA/AO type 11C): a preliminary comparison of clinical efficacy

Abstract

Background: This study aimed to compare the clinical efficacy of locking plate and intramedullary nail fixations in the treatment of patients with OTA/AO type 11C proximal humerus fractures.

Methods: We retrospectively analyzed the data of patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures who underwent surgery at our institution from June 2012 to June 2017. Perioperative indicators, postoperative morphological parameters of the proximal humerus, and Constant-Murley scores were evaluated and compared.

Results: Sixty-eight patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures were enrolled in this study. Overall, 35 patients underwent open reduction and plate screw internal fixation, and 33 patients underwent limited open reduction and locking of the proximal humerus with intramedullary nail internal fixation. The total cohort had a mean follow-up duration of 17.8 months. The mean operation time of the locking plate group was significantly longer than that of the intramedullary nail group (P < 0.05), while the mean bleeding volume was significantly higher in the locking plate group than that in the intramedullary nail group (P < 0.05). The initial neck-shaft angles, final neck-shaft angles, forward flexion ranges, or Constant-Murley scores did not show significant differences between the two groups (P > 0.05). Complications, including screw penetrations, acromion impingement syndrome, infection, and aseptic necrosis of the humeral head, occurred in 8 patients (8/35, 22.8%) in the locking plate group and 5 patients in the intramedullary nail group (5/33, 15.1%; including malunion and acromion impingement syndrome), with no significant difference between the groups (P > 0.05).

Conclusions: Similar satisfactory functional results can be achieved with locking plates and intramedullary nailing for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures, with no significant difference in the number of complications between these two techniques. However, intramedullary nailing has advantages over locking plates for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures in terms of operation time and bleeding volume.

Keywords: Clinical efficacy; Intramedullary nail; Locking plate; OTA/AO type 11C1.1 and 11C3.1; Proximal humerus neck fractures.

Fig. 1

An example case of a right proximal humerus fracture in a 65-year-old woman treated with locking plate internal fixation. (A) X-ray images showing the fractures in the anatomical neck of the right humerus and the greater tuberosity, as well as valgus cottage and greater tuberosity displacement; (B) CT scan of the fracture and displacement; (C) Anterior posterior X-ray image showing good reduction of the anatomical neck and greater tuberosity fracture. CT, computed tomography

Fig. 2

(A) A photograph of a triangular towel; (B) A picture of a patient hanging with a triangle towel after surgery

Fig. 3

An example case of a right proximal humerus fracture in a 54-year-old woman treated with intramedullary nail fixation. (A) X-ray image showing the fractures in the anatomical neck of the right humerus and the greater tuberosity, as well as valgus cottage and greater tuberosity displacement; (B) CT scan of the fracture and displacement; (C) Postoperative anteroposterior X-ray image showing good reduction of the anatomical neck and greater tuberosity fracture. The proximal and distal interlocking screws satisfactorily positioned; (D) Anteroposterior X-ray image of the right humerus anatomical neck and greater tuberosity showed good healing, no loosening of internal fixation, and no displacement of fracture at one year postoperatively. CT, computed tomography

Fig. 4

Photographs of the incision at one year postoperatively (A). The function of forward flexion (B), external rotation (C), and internal rotation (D) recovered well