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

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Clinical Orthopaedics and Related Research®

Abstract

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.

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Acknowledgments

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

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Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, University of Rostock, Schillingallee 35, D-18055, Rostock, Germany

    G. Gradl MD, PhD, A. Dietze MD & T. Mittlmeier MD, PhD

  2. Center for Musculoskeletal Surgery, Department of Trauma and Reconstructive Surgery, Humboldt University, University Medicine Berlin Charité, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany

    M. Kääb MD, PhD

  3. Institute for Biometrics and Clinical Epidemiology, Humboldt University, University Medicine Berlin Charité, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany

    W. Hopfenmüller MD, PhD

Authors
  1. G. Gradl MD, PhD
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  2. A. Dietze MD
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  3. M. Kääb MD, PhD
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  4. W. Hopfenmüller MD, PhD
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  5. T. Mittlmeier MD, PhD
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Corresponding author

Correspondence to A. Dietze MD.

Additional information

This work was performed at University of Rostock and the Campus Virchow and Campus Benjamin Franklin of Humboldt University.

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Gradl, G., Dietze, A., Kääb, M. et al. Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation?. Clin Orthop Relat Res 467, 2986–2993 (2009). https://doi.org/10.1007/s11999-009-0916-5

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  • DOI: https://doi.org/10.1007/s11999-009-0916-5

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