Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation?

  • G. Gradl
  • A. Dietze
  • M. Kääb
  • W. Hopfenmüller
  • T. Mittlmeier
Original Article


The optimal surgical treatment of displaced proximal humeral fractures is controversial. New implants providing angular stability have been introduced to maintain the intraoperative reduction. In a multi-institutional study, we prospectively enrolled and followed 152 patients with unilateral displaced and unstable proximal humeral fractures treated either with an antegrade angular and sliding stable proximal interlocking nail or an angular stable plate. Fractures were classified according to the Neer four-segment classification. Clinical, functional, and radiographic followups were performed 3, 6, and 12 months after surgery. Absolute and relative (to the contralateral shoulder) Constant-Murley scores were used to assess postoperative shoulder function. Using age, gender, and fracture type, we identified 76 pairs (152 patients) for a matched-pairs analysis. Relative Constant-Murley scores 12 months after treatment with an angular and sliding stable nail and after plate fixation were 81% and 77%, respectively. We observed no differences between the two groups. Stabilization of displaced proximal humeral fractures with either an angular stable intramedullary or an extramedullary implant seems suitable with both surgical treatment options.

Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Humeral Head Intramedullary Nailing Plate Fixation Proximal Humeral Fracture Head Fragment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Helga Krentz, Institute of Biostatistics, University of Rostock, for assistance in the statistical data analysis.


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Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • G. Gradl
    • 1
  • A. Dietze
    • 1
  • M. Kääb
    • 2
  • W. Hopfenmüller
    • 3
  • T. Mittlmeier
    • 1
  1. 1.Department of Trauma and Reconstructive SurgeryUniversity of RostockRostockGermany
  2. 2.Center for Musculoskeletal Surgery, Department of Trauma and Reconstructive SurgeryHumboldt University, University Medicine Berlin CharitéBerlinGermany
  3. 3.Institute for Biometrics and Clinical EpidemiologyHumboldt University, University Medicine Berlin CharitéBerlinGermany

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