Clinical Orthopaedics and Related Research®

, Volume 470, Issue 2, pp 602–609 | Cite as

Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures

  • Gerhard Konrad
  • Laurent Audigé
  • Simon Lambert
  • Ralph Hertel
  • Norbert P. Südkamp
Clinical Research



There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures.


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.

Patients and 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.


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.


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.

Level of Evidence

Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.


Rotator Cuff Proximal Humeral Fracture Plate Group Lock Plate Fixation Nail Fixation 
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 the following clinics and investigators for participation in this study:

PHN study arm: Medizinische Einrichtungen der Universität, Unfallchirurgie, Bonn, Germany (C. Rangger); Centro Traumatologico Ortopedico, Firenze, Italy (R. Angeloni); UZ Gasthuisberg, Leuven, Belgium (S. Nijs); Royal Liverpool University Hospital, Liverpool, United Kingdom (C. Sinopidis); Johannes Gutenberg Universitätsklinikum, Klinik für Unfallchirurgie, Mainz, Germany (J. Blum); Università di Padova, Ortopedia e Traumatologia, Padova, Italy (A. Olmeda); Vogtlandklinikum Plauen, Plauen, Germany (W. Merbold); Kardinal Schwarzenberg’schen Krankenhaus, Abteilung für Unfallchirurgie, Schwarzach, Austria (F. Genelin); Unfallkrankenhaus Meidling, Wien, Austria (H. Matuschka); Klinikum Worms gGmbH, Worms, Germany (J. Blum).

PHILOS study arm: Rätisches Kantons- und Regionalspital, Chur, Switzerland (C. Sommer); Spital und Pflegeheim Davos, Davos Platz, Switzerland (C. Ryf); Hôpital Cantonal de Fribourg, Fribourg, Switzerland (G. Kohut); Westpfalz-Klinikum GmbH, Unfallchirurgie Klinik, Kaiserslautern, Germany (H. Winkler); Kantonsspital Luzern, Chirurgie/Traumatologie, Luzern, Switzerland (R. Babst); Klinikum Rosenheim, Unfall- und Wiederherstellungschirurgie, Rosenheim, Germany (G. Regel); St. Göran’s Hospital, Stockholm, Sweden (A. Ekelund); BG Unfall- und Universitätsklinik, Tübingen, Germany (D. Höntzsch).

LPHP study arm: Charité Universitätsmedizin Berlin, Zentrum für Muskuloskeletale Chirurgie, Berlin, Germany (N. Haas); Allgemeines Krankenhaus Celle, Celle, Germany (H-J. Oestern); Albert-Ludwigs-Universität, Orthopädie und Traumatologie, Freiburg, Germany (N. Südkamp); Universitätsklinik für Unfallchirurgie Graz, Graz, Austria (M. Plecko); Academic Medical Center Groningen, Department of Traumatology, Groningen, Netherlands (H. Ten Duis); Evangelisches Diakoniewerk Friederikenstift, Unfallklinik, Hannover, Germany (H. Lill); Universität Leipzig, Klinik für Unfall- und Wiederherstellungschirurgie, Leipzig, Germany (C. Josten).


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Gerhard Konrad
    • 1
  • Laurent Audigé
    • 2
  • Simon Lambert
    • 3
  • Ralph Hertel
    • 4
  • Norbert P. Südkamp
    • 5
  1. 1.Orthopaedic and Trauma SurgeryKKH ErdingErdingGermany
  2. 2.AO Clinical Investigation and DocumentationDübendorfSwitzerland
  3. 3.Shoulder and Elbow ServiceRoyal National Orthopaedic HospitalStanmoreGreat Britain, UK
  4. 4.Clinic for Orthopaedic SurgeryLindenhofspital BernBernSwitzerland
  5. 5.Department of Orthopaedic and Trauma SurgeryAlbert-Ludwigs-University FreiburgFreiburgGermany

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