Comparison of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FAN Wenbin ^1,2,3 , CUI Xueliang ^1,2,3 , SHI Liu ^1,2,3 , XIE Tian ^1,2,3 , RUI Yunfeng ^1,2,3 ,  CHEN Hui ^1,2,3

1. Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China;
2. Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China;
3. Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China;

Corresponding author：

CHEN Hui, Email: chenhui@seu.edu.cn

Keywords：

Proximal humeral fracture; locking plate; intramedullary nail; internal fixation; the elderly

DOI：

10.7507/1002-1892.202107003

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Objective To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. Methods A retrospective analysis was conducted on 86 elderly patients with Neer two- and three-part fractures of the proximal humerus met the selection criteria between January 2015 and December 2018. Forty-six patients were treated with locking plate fixation (locking plate group), and 40 patients with intramedullary nail fixation (intramedullary nail group). There was no significant difference in gender, age, cause of injury, fracture side and type, time from injury to operation, and comorbidities between the two groups (P>0.05). Visual analogue scale (VAS) score, American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score, and shoulder range of motion (forward flexion, abduction, and external rotation) were compared between the two groups. X-ray films were taken to assess the fracture healing, and the neck-shaft angle was measured at 2 days after operation and at last follow-up, and the difference between the two time points was calculated. Results Patients in both groups were followed up 18-40 months, with an average of 30.4 months. There was no significant difference in follow-up time between the two groups (t=−0.986, P=0.327). X-ray films reexamination showed that the fractures of two groups healed, and the healing time was (11.3±2.1) weeks in locking plate group and (10.3±2.0) weeks in intramedullary nail group, which had significant difference between the two groups (t=2.250, P=0.027). The difference of neck-shaft angle was (7.63±7.01)° in locking plate group and (2.85±2.82)° in intramedullary nail group, which had significant difference between the two groups (t=4.032, P<0.001). There was no significant difference in Constant-Murley score, ASES score, VAS score, and shoulder range of motion between the two groups at last follow-up (P>0.05). Complications occurred in 13 cases (28.3%) of locking plate group and in 4 cases (10.0%) of intramedullary nail group, and the difference between the two groups was significant (χ²=4.498, P=0.034). Conclusion Both locking plates and intramedullary nails can be used for the treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. The intramedullary nail fixation surgery is more minimally invasive, which has fewer postoperative complications and faster fracture healing.

Citation： FAN Wenbin, CUI Xueliang, SHI Liu, XIE Tian, RUI Yunfeng, CHEN Hui. Comparison of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 274-278. doi: 10.7507/1002-1892.202107003 Copy

1.	Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury, 2008, 39(3): 284-298.
2.	Pinkas D, Wanich TS, DePalma AA, et al. Management of malunion of the proximal humerus: current concepts. J Am Acad Orthop Surg, 2014, 22(8): 491-502.
3.	Tepass A, Rolauffs B, Weise K, et al. Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970-2009. Patient Saf Surg, 2013, 7(1): 34. doi: 10.1186/1754-9493-7-34.
4.	Lorenz G, Schönthaler W, Huf W, et al. Complication rate after operative treatment of three- and four-part fractures of the proximal humerus: locking plate osteosynthesis versus proximal humeral nail. Eur J Trauma Emerg Surg, 2021, 47(6): 2055-2064.
5.	Yoon RS, Dziadosz D, Porter DA, et al. A comprehensive update on current fixation options for two-part proximal humerus fractures: a biomechanical investigation. Injury, 2014, 45(3): 510-514.
6.	Maier D, Jaeger M, Izadpanah K, et al. Proximal humeral fracture treatment in adults. J Bone Joint Surg (Am), 2014, 96(3): 251-261.
7.	Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury, 2011, 42(11): 1283-1288.
8.	常祖豪, 张伟. 内侧支撑重建增强固定技术在肱骨近端骨折治疗中的研究进展. 中国修复重建外科杂志, 2021, 35(3): 375-380.
9.	Chandrappa MH, Hajibandeh S, Hajibandeh S. Postoperative outcomes of initial varus versus initial valgus proximal humerus fracture: A systematic review and meta-analysis. J Clin Orthop Trauma, 2017, 8(1): 14-20.
10.	Robinson CM, Stirling PHC, MacDonald DJ, et al. Open reduction and long locking plate fixation of complex proximal humeral metadiaphyseal fractures. J Bone Joint Surg (Am), 2020, 102(24): 2146-2156.
11.	Gardner MJ, Weil Y, Barker JU, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 2007, 21(3): 185-191.
12.	Lee CW, Shin SJ. Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation. J Shoulder Elbow Surg, 2009, 18(1): 83-88.
13.	Mehta S, Chin M, Sanville J, et al. Calcar screw position in proximal humerus fracture fixation: Don’t miss high! Injury, 2018, 49(3): 624-629.
14.	Wang Q, Sheng N, Rui B, et al. The neck-shaft angle is the key factor for the positioning of calcar screw when treating proximal humeral fractures with a locking plate. Bone Joint J, 2020, 102-B(12): 1629-1635.
15.	李波, 熊文峰. 锁定钢板治疗肱骨近端骨折中螺钉穿透关节面的研究进展. 中国修复重建外科杂志, 2021, 35(4): 403-408.
16.	Jia X, Chen Y, Qiang M, et al. Detection of intra-articular screw penetration of proximal humerus fractures: Is postoperative computed tomography the necessary imaging modality? Acad Radiol, 2019, 26(2): 257-263.
17.	李刚, 魏万富, 刘欣, 等. 髓内钉与锁定钢板治疗老年肱骨近端骨折疗效比较. 中华医学杂志, 2020, 100(41): 3240-3245.
18.	Dilisio MF, Nowinski RJ, Hatzidakis AM, et al. Intramedullary nailing of the proximal humerus: evolution, technique, and results. J Shoulder Elbow Surg, 2016, 25(5): e130-e138. doi: 10.1016/j.jse.2015.11.016.
19.	Dey Hazra RO, Blach RM, Ellwein A, et al. Latest trends in the current treatment of proximal humeral fractures—an analysis of 1162 cases at a level-1 trauma centre with a special focus on shoulder surgery. Z Orthop Unfall, 2021. doi: 10.1055/a-1333-3951.
20.	Dang KH, Jensen K, Dutta AK. Early outcomes of magnetic intramedullary compression nailing for humeral fractures. Eur J Orthop Surg Traumatol, 2021, 31(1): 23-31.

1. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury, 2008, 39(3): 284-298.
2. Pinkas D, Wanich TS, DePalma AA, et al. Management of malunion of the proximal humerus: current concepts. J Am Acad Orthop Surg, 2014, 22(8): 491-502.
3. Tepass A, Rolauffs B, Weise K, et al. Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970-2009. Patient Saf Surg, 2013, 7(1): 34. doi: 10.1186/1754-9493-7-34.
4. Lorenz G, Schönthaler W, Huf W, et al. Complication rate after operative treatment of three- and four-part fractures of the proximal humerus: locking plate osteosynthesis versus proximal humeral nail. Eur J Trauma Emerg Surg, 2021, 47(6): 2055-2064.
5. Yoon RS, Dziadosz D, Porter DA, et al. A comprehensive update on current fixation options for two-part proximal humerus fractures: a biomechanical investigation. Injury, 2014, 45(3): 510-514.
6. Maier D, Jaeger M, Izadpanah K, et al. Proximal humeral fracture treatment in adults. J Bone Joint Surg (Am), 2014, 96(3): 251-261.
7. Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury, 2011, 42(11): 1283-1288.
8. 常祖豪, 张伟. 内侧支撑重建增强固定技术在肱骨近端骨折治疗中的研究进展. 中国修复重建外科杂志, 2021, 35(3): 375-380.
9. Chandrappa MH, Hajibandeh S, Hajibandeh S. Postoperative outcomes of initial varus versus initial valgus proximal humerus fracture: A systematic review and meta-analysis. J Clin Orthop Trauma, 2017, 8(1): 14-20.
10. Robinson CM, Stirling PHC, MacDonald DJ, et al. Open reduction and long locking plate fixation of complex proximal humeral metadiaphyseal fractures. J Bone Joint Surg (Am), 2020, 102(24): 2146-2156.
11. Gardner MJ, Weil Y, Barker JU, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 2007, 21(3): 185-191.
12. Lee CW, Shin SJ. Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation. J Shoulder Elbow Surg, 2009, 18(1): 83-88.
13. Mehta S, Chin M, Sanville J, et al. Calcar screw position in proximal humerus fracture fixation: Don’t miss high! Injury, 2018, 49(3): 624-629.
14. Wang Q, Sheng N, Rui B, et al. The neck-shaft angle is the key factor for the positioning of calcar screw when treating proximal humeral fractures with a locking plate. Bone Joint J, 2020, 102-B(12): 1629-1635.
15. 李波, 熊文峰. 锁定钢板治疗肱骨近端骨折中螺钉穿透关节面的研究进展. 中国修复重建外科杂志, 2021, 35(4): 403-408.
16. Jia X, Chen Y, Qiang M, et al. Detection of intra-articular screw penetration of proximal humerus fractures: Is postoperative computed tomography the necessary imaging modality? Acad Radiol, 2019, 26(2): 257-263.
17. 李刚, 魏万富, 刘欣, 等. 髓内钉与锁定钢板治疗老年肱骨近端骨折疗效比较. 中华医学杂志, 2020, 100(41): 3240-3245.
18. Dilisio MF, Nowinski RJ, Hatzidakis AM, et al. Intramedullary nailing of the proximal humerus: evolution, technique, and results. J Shoulder Elbow Surg, 2016, 25(5): e130-e138. doi: 10.1016/j.jse.2015.11.016.
19. Dey Hazra RO, Blach RM, Ellwein A, et al. Latest trends in the current treatment of proximal humeral fractures—an analysis of 1162 cases at a level-1 trauma centre with a special focus on shoulder surgery. Z Orthop Unfall, 2021. doi: 10.1055/a-1333-3951.
20. Dang KH, Jensen K, Dutta AK. Early outcomes of magnetic intramedullary compression nailing for humeral fractures. Eur J Orthop Surg Traumatol, 2021, 31(1): 23-31.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly

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