Efficacy comparison of intramedullary nails, locking plates and conservative treatment for displaced proximal humeral fractures in the elderly.

Abstract

PURPOSE:

The incidence of proximal humeral fractures is high in the elderly, and the superior management of these fractures remains a controversy. The study aims to compare clinical outcomes of intramedullary nails, locking plates and conservative treatment for the management of displaced proximal humeral fractures in the elderly.

PATIENTS AND METHODS:

In this prospective study, a total of 198 patients with 2- or 3-part proximal humeral fractures who received fixation of locking plates or intramedullary nails or conservative treatment were included. The primary outcome was the 24-month Constant-Murley score. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) scores, the visual analog scale (VAS) pain scores, shoulder range of motion and complication rate.

RESULTS:

There were no statistically significant differences in the Constant-Murley scores and ASES scores among the plate group, the nail group and the conservative group for 2-part fractures. For 3-part fractures, Constant-Murley scores and ASES scores were lower in the conservative group compared with those in the plate group and the nail group. Besides, the conservative group showed a significantly lower external rotation during follow-ups. The complication rate was comparable among the plate group, the nail group and the conservative group for both 2-part and 3-part fractures.

CONCLUSION:

Similar satisfactory functional outcomes can be achieved with the locking plates, intramedullary nails or conservative treatment for 2-part proximal humeral fractures in the elderly. The advantages in functional outcomes favor locking plates and intramedullary nails in the management of 3-part proximal humeral fractures.

• Authors: Wei Ge, Qi Sun, Gen Li, Guanghua Lu, Ming Cai, ShaoHua Li
• Journal: Clinical interventions in aging (Clin Interv Aging) Vol. 12 Pg. 2047-2054 ( 2017) ISSN: 1178-1998 [Electronic] New Zealand
• PMID: 29238180 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Topics

• Aged
• Aged, 80 and over
• Bone Nails
• Bone Plates
• Conservative Treatment
• Female
• Fracture Fixation, Intramedullary (methods)
• Humans
• Incidence
• Internal Fixators
• Male
• Patient Satisfaction
• Prospective Studies
• Range of Motion, Articular
• Shoulder Fractures (surgery)
• Treatment Outcome