Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate

Purpose The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. Methods A prospective controlled randomized open-label two-arm study was performed. Ninety...

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Veröffentlicht in:International orthopaedics 2021-11, Vol.45 (11), p.2917-2926
Hauptverfasser: Boyer, Patrick, Couffignal, Camille, Bahman, Mohammad, Mylle, Guy, Rousseau, Marc-Antoine, Dukan, Ruben
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Sprache:eng
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Zusammenfassung:Purpose The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. Methods A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN ( n  = 49) or LP ( n  = 50). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. Results Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (± 13.3,, and the mean follow-up was 66 months (± 13.5). At last follow-up, VAS was lower in the IMN group (0.9 (± 1.1) vs . 1.9 (± 1.7), p  = 0.001). The median Constant score was significantly higher in the IMN group (81.6 (± 10.9) points) vs. in the LP group (75.6 (± 19.5) points) ( p  = 0.043), and ASES score was also significantly higher in the IMN group (86.3 (± 9.5) vs. 75.2 (± 19.6), p  = 0.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p  = 0.003). Revision surgery was higher in the LP group (37% vs. 21%). Conclusion Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.
ISSN:0341-2695
1432-5195
DOI:10.1007/s00264-021-05217-9