Comparative Study On The Efficacy Of Locking Plate And Intramedullary Nail In Treatment Of Proximal Humeral Fractures

Objective:Comparing the clinical efficacy of locking plate and intramedullary nail in the treatment of two or three part proximal humeral fractures.Methods:A review study was conducted among 41 patients who were admitted to Zhongda Hospital from January 2015 to December 2016 and whose case information was complete.Including 24 patients undergoing locking plate surgery(8 males and 16 females,average63.6±14.0 years,14 cases of two-part fracture,10 cases of three-part fracture)and 17 patients undergoing intramedullary nailing(6 males and 11 females,average 68.0±14.8 years old;10cases of two-part fracture,7 cases of three-part fracture).All patients had no serious underlying disease affecting fracture healing,and all had surgery within one week after the injury.The operative time,intraoperative blood loss,length of hospital stay,postoperative complications,and the follow-up of the shoulder function Constant-Murley scores and VAS pain scores at 6 weeks,3 months,and 1 year were recorded.Result:All the 41 patients were followed up.At the 6 weeks follow-up,the average VAS score of the plate group was(2.58±0.65)points,and that of the Constant-Murley score was(67.58±4.11)points;the mean VAS score of the intramedullary nail group was(1.29±0.69)points and Constant-Murley score was(71.20±4.08)points.During follow-up at 3 months after operation,the average VAS score of the plate group was(1.08±0.50)points,the average Constant-Murley score was(82.71±6.46)points;and the VAS score of the intramedullary nail group was(0.71±0.47)points and Constant-Murley score was(82.59±5.04)points.At the follow-up period of 12 months after surgery,the mean VAS score in the plate group was(0.79±0.66)points,the average Constant-Murley score was(89.50±6.51)points;and the mean VAS score in the intramedullary nail group was(0.53±0.51)points and Constant-Murley score was(88.82±5.25)points.There was no significant difference in the duration of surgery and days of hospitalization between the 2 groups,whereas the amount of bleeding in the intramedullary nail group was significantly less than the locked plate group.At the last follow-up,no infection,fracture nonunion,and humeral head necrosis occurred in either group.For the two-part and three-part proximal humeral fractures,the scores of shoulder function and pain scores in the intramedullary nail group were better than those in the locking plate group(P<0.05)at 6 weeks after surgery.On the other hand,the results of shoulder function at the 3th and 12 th month were similar in the 2 groups.Conclusion:Similar results were achieved for the treatment of proximal humeral fractures by locking plate and intramedullary nail.However,intramedullary nail treatment has the advantages of less trauma and faster recovery of shoulder function in the near future.