Intramedullary nailing vs. locking plate osteosynthesis in proximal humeral fractures: Long-term outcome

• Published in: Der Unfallchirurg Vol. 118; no. 8; pp. 686 - 692
• Main Authors: von Rüden, C, Trapp, O, Hierholzer, C, Prohaska, S, Wurm, S, Bühren, V
• Format: Journal Article
• Language: German
• Published: Germany 01.08.2015
• Subjects: Adult; Aged; Aged, 80 and over; Bone Plates; Bone Screws; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fracture Fixation, Intramedullary - adverse effects; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Fracture Healing; Humans; Longitudinal Studies; Male; Middle Aged; Retrospective Studies; Shoulder Fractures - complications; Shoulder Fractures - diagnosis; Shoulder Fractures - surgery; Shoulder Pain - diagnosis; Shoulder Pain - etiology; Shoulder Pain - prevention & control; Treatment Outcome
• ISSN: 1433-044X
• DOI: 10.1007/s00113-013-2530-y

For the treatment of proximal humeral fractures two major therapeutic principles can be employed: intramedullary nailing (PHN) or locking plate osteosynthesis. The aim of this study was to evaluate and compare clinical and radiological long-term outcome of proximal humeral fracture stabilization using PHN or angular stable plating. In a retrospective study between March 2009 and March 2010, we analyzed 72 out of 118 patients with unified proximal humeral fracture who had been treated at least 3 years previously using PHN (44 patients) or angular stable plating (28 patients) in a level 1 trauma center. Functional and radiological outcomes were assessed at least 3 years after trauma using the Constant and Murley score and SF-36 score. According to the Neer classification, there were 31 3-part fractures (PHN: 23; plate: 8) and 41 4-part fractures (PHN: 21; plate: 20), respectively. No clinical symptoms after 3 years were observed in 42 patients, whereas in 30 patients clinical symptoms were evaluated related to pain and/or loss of function. Functional outcome using the Constant and Murley score demonstrated a total score of 73 points (ipsilateral side) vs. 88 points (contralateral side) in all evaluated patients, on average. Both PHN and angular stable plating are adequate treatment options for proximal humeral fractures. Both systems require precise preoperative planning and advanced surgical experience. No significant differences in long-term clinical and radiological outcome between implants regarding fracture classification, age of patient, and choice of implant were found.