Similar outcomes for intramedullary nail versus locking plate in treating proximal humerus fractures: a retrospective study

Objective The aim of this study was to compare the clinical and radiographic outcomes and complications following locking plate versus intramedullary nail fixation of 2- and 3-part proximal humerus fractures. Methods A total of 97 patients (47, nail group; 50, plate group) were included in this retrospective study. The patients were treated either with an intramedullary nail or a locking plate. The length of the surgical incision, operative time, healing time, Constant-Murley score, and postoperative complications were compared between groups. Results The average length of the incision, operative time of intramedullary nail group were significantly less than locking plate group (P<0.05). There were no significant differences in the average fracture union time, Constant-Murley functional score, postoperative neck-shaft angle and neck-shaft angle a year after surgery (P>0.05). Postoperative complications in the plate group included delayed union (n=2), screw cutout (n=1), varus malunion (n=3), displacement of the greater tubercle (n=1), and subacromial impingement syndrome (n=1). Complications in the nail group included delayed union (n=1), screw cutout (n=3), displacement of the greater tubercle (n=4), and subacromial impingement syndrome (n=3); varus malunion was not observed. Conclusion Both the nail and locking plate were effective and had similar outcomes in patients with 2- or 3-part proximal humerus fractures. For valgus-type fractures, the plate had an advantage over the nail; for varus-type, the nail was a better option.