Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study

• Published in: International orthopaedics 2020-10, Vol.44 (10), p.2113-2121
• Main Authors: Akalın, Yavuz, Şahin, İsmail Gökhan, Çevik, Nazan, Güler, Burak Olcay, Avci, Özgür, Öztürk, Alpaslan
• Format: Article
• Language: English
• Subjects: Bone Nails; Bone Plates; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Intramedullary - adverse effects; Humans; Humeral Fractures - diagnostic imaging; Humeral Fractures - surgery; Humerus; Medicine; Medicine & Public Health; Original Paper; Orthopedics; Prospective Studies; Treatment Outcome
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-020-04696-6

Purpose To compare the radiological and clinical outcomes of interlocking nail (ILN) and locking plate fixation (LCP) for humeral shaft fractures. Methods A total of 63 patients with displaced humeral shaft fractures between October 2014 and January 2017 were evaluated prospectively. They were divided randomly into two as LCP fixation (group 1) and interlocking nail (ILN) (group 2). Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), the University of California at Los Angeles (UCLA) shoulder scores, and Short Form-36 (SF-36) questionnaires, and pain was assessed with visual analogue scale (VAS). Results After fracture callus was radiologically observed, DASH, ASES, and UCLA scores as well as SF-36 questionnaires and VAS results were noted to have no significant difference between the two groups ( p  = 0.109, p  = 0.082, p  = 0.146, p  = 0.322, and p  = 0.175, respectively). At the last follow-up (post-operative 24 months), the UCLA score was significantly better in group 1 ( p  = 0.034), whereas VAS result was significantly worse in group 2 ( p  = 0.017). DASH, ASES scores, and SF-36 questionnaires had no difference ( p  = 0.193, p  = 0.088, p  = 0.289). Other parameters revealed no significant differences. Fracture consolidation was observed at a mean of four months in both groups (3 to 7 months in group 1 and 3 to 8 months in group 2) ( p  = 0.189). Four patients in group 1 and five patients in group 2 underwent surgery for nonunion ( p  = 0.725). Post-operative radial nerve palsy was seen in one patient in group 2. Two patients in group 1 with superficial infection were treated with antibiotics, and they recovered. Conclusions Regarding our results, the LCP group had significantly better shoulder function than the ILN group, whereas the ILN group had significantly less pain, with similar complication rates. Therefore, both procedures are favourable surgical options for patients with humeral shaft fractures.