For humerus neck factures, the nail is as good as the plate
South Korean researchers at the Yonsei University College of Medicine in Seoul compared two methods in 69 patients with displaced surgical neck fracture of the humerus: closed reduction internal fixation with an antegrade intramedullary nail (IMN, n = 38, group A) or an open reduction internal fixation with a locking plate and screws (n=31, group B). Primary outcomes included scores on the following scales: pain visual analog scale, University of California Los Angeles (UCLA) Shoulder Score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM scale).
At the two-year follow up, all patients had similar visual analog scale pain score (A: 1.3 vs. B: 0.9), ASES score (90.2 vs. 91.9), and UCLA Shoulder Score (30.7 vs. 31.8). Active ROM scores did not show any significant difference between the groups either. Three cases of complications occurred in the IMN group (1 nonunion requiring autogenous iliac crest bone graft, 2 cases of screw loosening).
In patients with displaced surgical neck fracture of the humerus, both IM nailing and locked plate fixation lead to satisfactory outcomes after two years: There were no significant differences regarding pain or range of motion.