title: Surgical treatment of two-part fractures of the proximal humerus: comparison of fixed-angle plate osteosynthesis and Zifko nails.
abstract: BACKGROUND
  Closed reduction and percutaneous pinning using Zifko nails offer the advantage of a minimal soft-tissue dissection but have been criticised for limited stability and secondary fracture dislocation. Angular stable plate osteosynthesis enables anatomic reduction, but carries the risk of soft tissue traumatisation and consecutive humeral head necrosis. The present study compares the clinical and radiological outcome of patients with dislocated two-part fractures of the proximal humerus, who were treated with either Zifko nails or angular stable plate fixation.
  
  
  METHODS
  A matched-pair analysis was performed and patient groups were matched according to age (3 years), sex and fracture type. As many as 11 pairs of patients with a minimum follow-up of 3 years were formed and investigated radiographically and clinically using the Constant score (CS) and the visual analogue scale (VAS) for the patients' satisfaction.
  
  
  RESULTS
  At the time of follow-up, the absolute CS was 83 points in the PHP group and 78 points in the Zifko group (n.s.). Neither in the age and gender-corrected CS was found a significant difference between the study groups (PHP 104 29, Zifko 95 17, n.s.) nor in terms of subjective patient satisfaction (PHP 6.54; Zifko 7.8, n.s.). The complication rate was also comparable in both groups.
  
  
  CONCLUSIONS
  In conclusion, Zifko nailing represents a cost-effective minimally invasive surgical method with a complication rate and clinical outcome comparable to that after angular stable osteosynthesis by angular stable plate fixation in the treatment of two-part fractures of the proximal humerus.
authors.affiliation: Department of Orthopaedics, Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charité platz 1, 10117 Berlin, Germany. Doerte.Matziolis@Charite.de
authors.forename: Doerte
authors.initials: D
authors.lastname: Matziolis
authors.forename: Max
authors.initials: M
authors.lastname: Kaeaeb
authors.forename: Souska Sophie
authors.initials: SS
authors.lastname: Zandi
authors.forename: Carsten
authors.initials: C
authors.lastname: Perka
authors.forename: Stefan
authors.initials: S
authors.lastname: Greiner
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult