‘Satisfactory’ results seen with either locking plates or locking nails for humeral neck fractures

Zhu Y. J Bone J Surg (Am). 2011; 93:159-168. doi:10.2106/JBJS.J.00155.

The results of this level 1 study showed no significant differences in clinical outcomes at 3-year follow-up between patients treated with either locking intramedullary nails or locking plates for 2-part surgical neck fractures.

Yiming Zhu, MD, and colleagues at Beijing Ji Shui Tan Hospital in China compared 51 patients with fresh 2-part proximal humeral surgical neck fractures who were randomized to treatment with either a locking plate or locking intramedullary (IM) nail. The patients underwent radiographic and clinical assessment using the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score at 1- and 3-years postoperatively.

The investigators discovered that all of the patients achieved union within 3 months of their procedures, according to the study abstract. The study revealed a complication rate of 31% in the locking plate group and 4% in the locking nail group at 1-year follow-up. The investigators also found significantly better VAS scores for shoulder pain and ASES scores in the locking plate group compared with the locking nail group at that time point. While the investigators discovered significant improvements in both groups from 1-year to 3-year follow-up regarding all of the clinical measures, they found no significant differences between the groups at 3 years.

“Satisfactory results can be achieved with either implant in the treatment of 2-part proximal humeral surgical neck fractures,” the authors concluded. “There was no difference regarding the ASES scores between these two implants at the time of the final, 3-year follow-up. The complication rate was lower in the locking intramedullary nail group, while fixation with a locking plate had the advantage of a better 1-year outcome.”