Locking plate fixation versus intramedullary nail fixation for the treatment of multifragmentary proximal humerus fractures (OTA/AO type 11C): a preliminary comparison of clinical efficacy

Abstract

Background This study aimed to compare the clinical efficacy of locking plate and intramedullary nail fixations in the treatment of patients with OTA/AO type 11C proximal humerus fractures. Methods We retrospectively analyzed the data of patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures who underwent surgery at our institution from June 2012 to June 2017. Perioperative indicators, postoperative morphological parameters of the proximal humerus, and Constant–Murley scores were evaluated and compared. Results Sixty-eight patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures were enrolled in this study. Overall, 35 patients underwent open reduction and plate screw internal fixation, and 33 patients underwent limited open reduction and locking of the proximal humerus with intramedullary nail internal fixation. The total cohort had a mean follow-up duration of 17.8 months. The mean operation time of the locking plate group was significantly longer than that of the intramedullary nail group (P < 0.05), while the mean bleeding volume was significantly higher in the locking plate group than that in the intramedullary nail group (P < 0.05). The initial neck–shaft angles, final neck–shaft angles, forward flexion ranges, or Constant–Murley scores did not show significant differences between the two groups (P > 0.05). Complications, including screw penetrations, acromion impingement syndrome, infection, and aseptic necrosis of the humeral head, occurred in 8 patients (8/35, 22.8%) in the locking plate group and 5 patients in the intramedullary nail group (5/33, 15.1%; including malunion and acromion impingement syndrome), with no significant difference between the groups (P > 0.05). Conclusions Similar satisfactory functional results can be achieved with locking plates and intramedullary nailing for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures, with no significant difference in the number of complications between these two techniques. However, intramedullary nailing has advantages over locking plates for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures in terms of operation time and bleeding volume.

Proximal Humerus Fracture Treated with Locking Plate Fixation and Fibula Autograft: Case Report

“…Proximal humerus fractures, particularly anatomical neck fractures in older adults, are prone to failure of internal fixation, commonly resulting in poor prognosis and shoulder function. Patient factors, such as reduced local bone density, incomplete medial calcar support, and humeral head ischemia, may all precipitate these failures, in addition to surgeon-related factors, including inadequate fracture reduction and postoperative displacement [16]. OTA/AO type C proximal humerus fractures remain particularly challenging to treat due to these above-mentioned factors, in addition to difficulties in managing bone voids that remain after fracture reduction.…”

Straight intramedullary MultiLoc nails for displaced proximal humeral fractures: health status, radiographic results, clinical outcome, and complications

“…Interlocking Targon nail are more minimally invasive than locking plates and the intraoperative blood loss was much lower than that of the locking plate group [ 13 ]. Minghui Wang .et al found that TriGen straight nail has advantages over locking plates for OTA/AO type 11C1.1 and 11C3.1 proximal humerus anatomical neck fractures in terms of operation time and bleeding volume, with no significant difference in the number of complications [ 14 ]. A meta-analysis included 13 comparative studies with 958 patients indicates that locking plates and intramedullary nails have similar performance in terms of the functional scores and total complication rate [ 15 ].…”