Two-Part Proximal Humerus Fractures: Whether to Plate or Nail?

Background: Displaced Two-part proximal humerus fractures are common orthopedic injuries for which surgical intervention is often indicated. Purpose-The purpose of this study is to compare two methods of fixation for two-part proximal humerus fractures, locking plate (LP) with screws versus intramedullary nailing (IMN), with respect to alignment, healing, patient outcomes, and complications. Method and material-A prospective study was performed on 61 cases of displaced two-part surgical neck fractures of the humerus. 30 shoulders were treated using IMN fixation and 31 others were fixated with LP. Results Clinical and radiological outcome of two groups were compared. American Shoulder Elbow Surgeon (ASES) Score was used to evaluate patients clinically which was not significant for 1-year follow-up. Radiographic comparison of fixation by X-Rays demonstrated an average neck-shaft angle of 121.9° and 124° in the IMN group and LP group respectively. 117.7° of forward elevation in the IMN group and 136.3o in the LP group, which were significant. Operating time for both the procedures was found to be significant. Complications were not found to be significant. Conclusion: Our results suggest that either LP fixation or IMN fixation for a two-part proximal humerus fracture provides acceptable fixation and both the procedures have some limitations over other. Although forward flexion and functional outcome were decreased in the IMN group, operative time was less and was significant.

[1]  D. Dines,et al.  What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty? , 2016, Clinical orthopaedics and related research.

[2]  L. Audigé,et al.  Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures , 2012, Clinical orthopaedics and related research.

[3]  J. Fernández-Valencia,et al.  Comparative study between locking plates versus proximal humeral nail for the treatment of 2-part proximal humeral fractures , 2012, European Journal of Orthopaedic Surgery & Traumatology.

[4]  J. Macy.  Open Reduction and Internal Fixation of Proximal Humerus Fractures Using a Proximal Humeral Locked Plate: A Prospective Multicenter Analysis , 2010 .

[5]  A. Rangan,et al.  Protocol for the ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial: a pragmatic multi-centre randomised controlled trial of surgical versus non-surgical treatment for proximal fracture of the humerus in adults , 2009, BMC musculoskeletal disorders.

[6]  B. B. Putti,et al.  Locked Intramedullary Nailing versus Dynamic Compression Plating for Humeral Shaft Fractures , 2009, Journal of orthopaedic surgery.

[7]  M. Kääb,et al.  Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. , 2009, The Journal of bone and joint surgery. American volume.

[8]  J. Zuckerman,et al.  Early Complications in Proximal Humerus Fractures (OTA Types 11) Treated With Locked Plates , 2008, Journal of orthopaedic trauma.

[9]  Peter Helwig,et al.  Analysis of Efficacy and Failure in Proximal Humerus Fractures Treated With Locking Plates , 2007, Journal of orthopaedic trauma.

[10]  P. Rommens,et al.  Osteosynthese von Oberarmkopffrakturen , 2005, Der Chirurg.

[11]  K. Zyto.  Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. , 1998, Injury.

[12]  H. Asfazadourian,et al.  Results of non-operative and operative treatment of humeral shaft fractures. A series of 104 cases. , 1998, Chirurgie de la main.

[13]  R. Esser.  Treatment of Three- and Four-Part Fractures of the Proximal Humerus with a Modified Cloverleaf Plate , 1994, Journal of orthopaedic trauma.

[14]  F. Savoie,et al.  Open reduction and internal fixation of three-part fractures of the proximal humerus. , 1989, Orthopedics.

[15]  R. Hawkins,et al.  The three-part fracture of the proximal part of the humerus. Operative treatment. , 1986, The Journal of bone and joint surgery. American volume.

[16]  R H Cofield,et al.  Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. , 1983, Clinical orthopaedics and related research.

[17]  B. Nilsson,et al.  Epidemiology of fracture of the upper end of the humerus. , 1975, Clinical orthopaedics and related research.

[18]  C. Neer,et al.  Displaced proximal humeral fractures. I. Classification and evaluation. , 1970, The Journal of bone and joint surgery. American volume.