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-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.