Intramedullary nail versus locked plate in the treatment of two- and three-part proximal humerus fractures: a retrospective comparative study of 46 cases

Abstract

Objective: to retrospectively evaluate and compare the proportions of complications and radiographic findings of two- and three-part proximal humerus fracture osteosynthesis with two treatment methods: third-generation locked intramedullary nail and locked plate. Methods: 46 patients with a mean age of 58.9±16.6 years were evaluated between January 2020 and January 2021. In sixteen cases (34.8%), an intramedullary nail was used, and in thirty cases (65 .2%), the proximal humerus locked plate. The evaluation used included the rate of complications with a minimum follow-up of 6 months postoperatively and radiographic evaluation. Results: there was no significant difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p=0.681). The nail group showed less residual loss in varus (cervicodiaphyseal angle, nail group 132.1º±2.3º, plate group 123.8º±10.1º; p<0.001). In the plaque group, women had a lower value (1.43±0.22) of the tuberosity-deltoid index (DTI) compared to men (1.58±0.11) (p=0.022). Conclusions: in the short-term follow-up, osteosynthesis, with locked plate and intramedullary nail, did not show differences in the proportions of complications. The nail group showed less change in the post-operative cervicodiaphyseal angle, however, there were two serious complications with cut out and varus deviation requiring a new surgical approach in the nail group.