title: Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures.
abstract: BACKGROUND
  There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures.
  
  
  OBJECTIVE
  The objective of this prospective observational study was to compare the clinical and radiologic outcomes of plate versus nail fixation of three-part proximal humeral fractures.
  
  
  METHODS
  Two hundred eleven patients with unstable three-part proximal humeral fractures were treated with ORIF using plate (PHILOS [proximal humeral interlocking system]/LPHP [locking proximal humerus plate]) or nail (PHN [proximal humeral nail]) osteosynthesis. Outcome measurements included pain, Constant and Murley and Neer scores, and the occurrence of complications at 3, 6, and 12 months postsurgery. Regression analysis and the likelihood ratio test were used to evaluate differences between the cohorts.
  
  
  RESULTS
  Throughout the 1-year followup period the Constant and Murley scores improved significantly for both cohorts; there was no significant difference between the nail group compared with the plate group. Also, 1-year Neer scores were similar between the two cohorts. Patients in the PHN group perceived significantly less pain compared with patients in the plate fixation group at 3, 6 and 12 months after surgery. We observed 79 local complications in 60 patients with no significant risk difference between the treatment groups; 35 intraoperative complications were directly related to the initial surgical procedure.
  
  
  CONCLUSIONS
  The similar 1-year outcomes for nail versus plate fixation of three-part proximal humeral fractures suggest that both techniques may be useful for internal fixation of these fractures. Many complications were related to incorrect surgical technique and therefore can be avoided. Advanced surgical skills and experience are considered to be more critical for successful operative treatment of three-part proximal humeral fractures than the selection of the implant.
  
  
  METHODS
  Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
authors: Orthopaedic and Trauma Surgery, KKH Erding, Bajuwarenstr. 5, 85435 Erding, Germany. gerhard.konrad@kkh-erding.de
authors: Gerhard
authors: G
authors: Konrad
authors: Laurent
authors: L
authors: Audigé
authors: Simon
authors: S
authors: Lambert
authors: Ralph
authors: R
authors: Hertel
authors: Norbert P
authors: NP
authors: Südkamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001858:Bone Nails; D001860:Bone Plates; D005060:Europe; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome