Midterm Treatment Outcomes of Proximal Humerus Fractures by Intramedullary Fixation

Abstract

Background.Treatment tactics of proximal humerus fractures remains a matter of dispute due to multiple cases of unsatisfactory outcomes and high rate of postoperative complications.The aim of the study—to evaluate midterm outcomes of intramedullary fixation for treatment the proximal humerus fractures in comparison with plate fixation.Material and Methods.The authors evaluated treatment outcomes of 175 patients with proximal humerus fractures who underwent surgery in the period from 2012 to 2017. Depending on the fixation method the patients were divided into two groups: the main group consisted of 107 patients who underwent intramedullary fixation by a nail of third generation; a comparison group — consisting of 68 patients who underwent fixation by a locking plate with angular stability.Results.In one year after intramedullary nail fixation the authors observed the excellent and good outcomes on Constant scale in 83.2% of cases, satisfactory — 12.1%, unsatisfactory — 4.7%. Patients who underwent plate fixation demonstrated the following outcomes: excellent and good — 73.5%, satisfactory — 17.7%, unsatisfactory — in 8.8%. Constant score increase was equal in the main and control groups and varied depending on the fracture type.Conclusion.Intramedullary nailing is an option for treatment of all fracture types of proximal humerus as well as for the cases of combined humeral neck and diaphysis fractures. Functional recovery parameters were higher in the main group of patients after intramedullary nailing.