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

Abstract

BACKGROUND:

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.

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

• Authors: C von Rüden, O Trapp, C Hierholzer, S Prohaska, S Wurm, V Bühren
• Journal: Der Unfallchirurg (Unfallchirurg) Vol. 118 Issue 8 Pg. 686-92 (Aug 2015) ISSN: 1433-044X [Electronic] Germany
• Vernacular Title: Marknagel- vs. winkelstabile Plattenosteosynthese bei proximalen Humerusfrakturen: Langzeitergebnisse.
• PMID: 24402670 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Bone Plates
• Bone Screws
• Female
• Fracture Fixation, Internal (adverse effects, instrumentation, methods)
• Fracture Fixation, Intramedullary (adverse effects, instrumentation, methods)
• Fracture Healing
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Retrospective Studies
• Shoulder Fractures (complications, diagnosis, surgery)
• Shoulder Pain (diagnosis, etiology, prevention & control)
• Treatment Outcome