Intramedullary Nailing Versus Locking Plate Fixation for Proximal Humerus Fractures: A Comparative Study

Abstract

Background: Proximal humerus fractures are common injuries associated with functional impairment and reduced shoulder mobility. Intramedullary nailing and locking plate fixation are widely used surgical techniques, although their comparative effectiveness remains debated. This study aimed to compare the clinical, functional, and radiological outcomes of these techniques.

Materials and Methods: This comparative observational study included 60 patients with displaced proximal humerus fractures, divided equally into intramedullary nailing (n = 30) and locking plate fixation (n = 30) groups. Operative duration, intraoperative blood loss, hospital stay, radiological union, Constant–Murley scores, shoulder mobility, postoperative pain, and complications were assessed over six months.

Results: Intramedullary nailing demonstrated significantly shorter operative duration (72.4 ± 14.6 vs. 94.8 ± 18.2 minutes; p < 0.001), lower blood loss (112.6 ± 38.4 vs. 186.8 ± 52.6 mL; p < 0.001), and shorter hospitalization (4.2 ± 1.3 vs. 5.1 ± 1.6 days; p = 0.020). Radiological union was comparable (12.8 ± 2.4 vs. 13.6 ± 2.8 weeks; p = 0.240). Six-month Constant–Murley scores were 82.4 ± 8.6 and 84.2 ± 7.9, respectively (p = 0.402). External rotation was significantly better following locking plate fixation (p = 0.044). Postoperative pain and complication rates were broadly comparable.

Conclusion: Intramedullary nailing demonstrated perioperative advantages, whereas locking plate fixation provided slightly better external rotation. Both techniques achieved comparable fracture union and functional recovery at six months. Surgical selection should consider fracture characteristics and patient requirements.