Treatment of Two-Part Proximal Humerus Fractures: Intramedullary Nail Compared to Locked Plating



Two-part proximal humerus fractures are common orthopedic injuries for which surgical intervention is often indicated. Choosing a fixation device remains a topic of debate.


The purpose of this study is to compare two methods of fixation for two-part proximal humerus fractures, locking plate (LP) with screws versus intramedullary nailing (IMN), with respect to alignment, healing, patient outcomes, and complications. To our knowledge, a direct comparison of these two devices in treating two-part proximal humerus fractures has never before been studied. We hope that our results will help surgeons assess the utility of LP versus IMN.


A retrospective chart review was performed on 24 cases of displaced two-part surgical neck fractures of the humerus. Twelve shoulders were treated using IMN fixation and 12 others were fixated with LP. Data collected included sociodemographic, operative details, and postoperative care and function.


Radiographic comparison of fixation demonstrated an average neck-shaft angle of 124° and 120° in the IMN group and LP group, respectively. Adjusted postoperative 6-month follow-up range of motion was 134° of forward elevation in the IMN group and 141 in the LP group. The differences in range of motion and in complication rates were not found to be significant.


Our results suggest that either LP fixation or IMN fixation for a two-part proximal humerus fracture provides acceptable fixation and results in a similar range of shoulder motion. Although complication rates were low and insignificant between the two groups, a trend toward increased complications in the IMN group is noted.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a significant conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Corresponding author

Correspondence to Kenneth A. Egol MD.

Additional information

Level of Evidence: Level III-2 (retrospective cohort study): Therapeutic Study

This work was performed at the New York University Hospital for Joint Diseases.

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Lekic, N., Montero, N.M., Takemoto, R.C. et al. Treatment of Two-Part Proximal Humerus Fractures: Intramedullary Nail Compared to Locked Plating. HSS Jrnl 8, 86–91 (2012).

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  • two-part proximal humerus fracture
  • locking plate
  • intramedullary nail
  • outcomes of proximal humerus fractures