Shoulder function after surgical treatment of displaced fractures of the humeral shaft: a randomized trial comparing antegrade intramedullary nailing with minimally invasive plate osteosynthesis.
BACKGROUND
Minimally invasive plate osteosynthesis for humeral shaft fractures has been described recently, but there are no randomized studies comparing the clinical results for shoulder function between this technique and locking intramedullary nailing.


METHODS
A prospective randomized study was performed. Forty-one humeral shaft fractures (40 patients) were randomized to be treated with a minimally invasive plate (n = 21) or a locking intramedullary nail (n = 19). Clinical and radiographic outcome assessments were conducted at 1 year postoperatively. Shoulder function was the primary outcome, as measured by the University of California, Los Angeles Shoulder Scale. Elbow function was measured by the Broberg-Morrey score, and fracture consolidation and complications were the main secondary outcomes.


RESULTS
At 1 year postoperatively, no significant difference was found with regard to shoulder function according to the University of California, Los Angeles scale between the minimally invasive plate and locking intramedullary nail (31.4 points vs 31.2 points, P = .98). There was also no difference in elbow function (94.8 points vs 94.1 points, P = .96). Complications were similar between the groups, without significant differences regarding infection (P > .99), symptomatic shoulder stiffness (P = .488), and neurapraxia of the lateral cutaneous nerve of the forearm (P = .475). Fracture union was achieved in all but 1 patient (2.4%) in the intramedullary nail group within 1 year after the surgical procedure.


CONCLUSIONS
There is no significant difference in shoulder function between antegrade intramedullary nailing and minimally invasive plate osteosynthesis for the treatment of displaced humeral shaft fractures, despite the limited power of our study.
Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil.
Eduardo
E
Benegas
Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil.
Arnaldo Amado
AA
Ferreira Neto
Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil. Electronic address: mgracitelli@gmail.com.
Mauro Emilio Conforto
ME
Gracitelli
Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil.
Eduardo Angeli
EA
Malavolta
Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil.
Jorge Henrique
JH
Assunção
Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil.
Flávia De Santis
Fde S
Prada
Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil.
Raul
R
Bolliger Neto
Hand, Microsurgery, and Trauma Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil.
Rames
R
Mattar
D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D012782:Shoulder / Q000503:physiopathology*
Shoulder; bone plates; fracture fixation; humeral shaft fractures; intramedullary nail; shoulder function