gms | German Medical Science

Purpose: This study was designed to compare clinical outcomes of the helical plate, intramedullary nailing (IMN), and long straight lateral plate technique for the treatment of complex proximal humeral metadiaphyseal fractures, and to point out the possible best fixation strategy for this injury.

Methods: We retrospectively identified complex proximal humeral metadiaphyseal fractures treated with open reduction and internal fixation between March 2017 to October 2021. The patients were divided into three groups according to the treatment procedure: a helical plating group (Group A), a IMN group (Group B), and a long straight lateral plating group (Group C). Preoperative demographical and clinical data were collected from the medical records. Duration of surgeries, blood transfusion, bone reduction quality, bone healing rate, the incidence of complications were recorded. Clinical evaluation comprised of Constant-Murley score for the shoulder function, DASH questionnaire (Disability of the Arm, Shoulder, and Hand) for the upper limb function, visual analogue scale (VAS) for pain, shoulder stiffness or instability and patient satisfaction.

Results: This study comprised of 81 patients (52 females and 29 males), sixteen underwent helical plate fixation, 12 underwent intramedullary nail fixation, 53 underwent long straight plate fixation. The mean operative time in group B was longer than those in group A and group C, and blood transfusion in Group B was lower than those in group A and group C. More than 80% patients in each group acquired better than good of bone reduction quality. However, there was no significant difference in operative time, blood transfusion, and shaft angulation among the three groups. Bone healing rates were 100%, 91.7%, and 94.3% in three groups, respectively. The mean shoulder flexions were 155.0°, 130.0°, and 150.0° respectively. The function indicators, Constant-Murley score, DASH score, VAS score, and patients’ satisfaction in Group A were significantly better than those in groups B and group C. Patents got similar results after nailing or straight plates fixation. In group A, three was no complications. In group B, one patient developed nonunion. In group C, complications were observed in 5 cases (9.4%).

Conclusion: Helical plates showed a higher bone union rate, a better limb functional result and a lower postoperative complication rate compared to the intramedullary nails or long straight locking plates. While, patients got similar outcomes after nailings or long straight plates fixation.