Locking Intramedullary Nails and Locking Plates in the Treatment of Two-Part Proximal Humeral Surgical Neck Fractures: A Prospective Randomized Trial with a Minimum of Three Years of Follow-up

BACKGROUND:Locking intramedullary nails and locking plates specially designed for proximal humeral fractures are widely used. The purpose of our study was to compare the outcomes between these two types of implants in patients with a two-part surgical neck fracture. The advantages and shortcomings of each method were analyzed. METHODS:A prospective randomized study was performed. Fifty-one consecutive patients with a fresh two-part surgical neck fracture were randomized to be treated with a locking intramedullary nail (n = 25) or a locking plate (n = 26). Clinical and radiographic assessments were conducted at one year and three years after the surgery. A visual analog scale (VAS) was used to assess shoulder pain. The American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores were recorded to evaluate shoulder function. RESULTS:Fracture union was achieved in all patients within three months after the surgery. At one year postoperatively, a significant difference (p = 0.024) was found with regard to the complication rate between the locking plate group (31%) and the locking nail group (4%). The average ASES score, median VAS score, and average strength of the supraspinatus were significantly better in the locking plate group (90.8 compared with 83.6 points [p = 0.021], 1.0 compared with 0.5 point [p = 0.042], and 77.4% compared with 64.3% [p = 0.032]). At three years postoperatively, no significant difference could be found in terms of any parameter between the two groups. Significant improvement in the VAS pain scores, ASES scores, and Constant-Murley scores were found between the one-year and three-year follow-up examinations in each group. CONCLUSIONS:Satisfactory results can be achieved with either implant in the treatment of two-part proximal humeral surgical neck fractures. There was no difference regarding the ASES scores between these two implants at the time of the final, three-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 one-year outcome. LEVEL OF EVIDENCE:Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.