Intramedullary versus locking plate fixation for proximal humerus fractures: indications and technical considerations

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomaterials science

Background:

• Increasing incidence of proximal humerus fractures (PHFs) in an aging population.
• Intramedullary nailing (IMN) and locking plate fixation (LPF) are common surgical treatments for PHFs.
• Ongoing debate regarding the optimal fixation method for PHFs.

Purpose of the Study:

• To review indications and technical considerations for IMN versus LPF in PHF management.
• To aid orthopedic surgeons in selecting the most appropriate surgical technique.
• To provide a comprehensive overview of current evidence comparing IMN and LPF for PHFs.

Main Methods:

• Narrative review approach.
• Comprehensive literature search of PubMed, Embase, and Cochrane Library.
• Inclusion of studies discussing proximal humerus fractures and either intramedullary nails or locking plate fixation.

Main Results:

• No significant differences in complications (avascular necrosis, hardware failure, infection, etc.) between IMN and LPF.
• Newer IMN designs have reduced early complications.
• Both techniques show potential for improved functional outcomes, reduced complications, and better pain management with refinement.

Conclusions:

• Both IMN and LPF effectively restore shoulder function in displaced PHFs.
• No clear superiority of one method over the other; choice is patient-specific.
• Factors influencing choice include fracture type, patient age, bone quality, functional goals, and surgeon experience.