Locking Plate Versus Intramedullary Nailing for Displaced Proximal Humeral Fractures
DOI:
https://doi.org/10.5281/zenodo.22327560Keywords:
Proximal humeral fracture, Locking plate, Intramedullary nailing, Avascular necrosis, Reverse shoulder arthroplastyAbstract
Background: Displaced proximal humeral fractures are common osteoporotic injuries, and locking plate fixation and
intramedullary nailing are the two dominant surgical options, yet their comparative merits remain debated.
Objective: To synthesise randomised and meta-analytic evidence comparing locking plate with intramedullary nailing, including
comparisons with non-operative care and arthroplasty. Methods: Narrative review of randomised trials, systematic reviews, meta-analyses, and biomechanical literature. Findings: Trials and meta-analyses pooling over 1,300 patients show no consistent difference in Constant or DASH scores between plate and nail, while nailing offers shorter operative time and less blood loss. Screw perforation/cut-out (up to 9.5%) and avascular necrosis (4.6-11%) dominate plate complications; reoperation rates reach 13.8-25%.
Conclusions: Locking plate and intramedullary nail achieve broadly comparable functional outcomes; implant choice should be
individualised by fracture pattern, bone quality, and surgeon experience, with arthroplasty reserved for unreconstructable or
high-risk elderly fractures.
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