Post-operative radiographic evaluation of reduction loss in unstable proximal humerus fractures: a comparative study of intramedullary nails and locking plates in patients over 50 years.

Abstract

Evaluate radiographic outcomes of patients over 50 years old who underwent plate or nail fixation for proximal humeral fractures within 6 months of follow-up. A retrospective observational study with 222 patients was conducted in a single tertiary hospital to evaluate radiographic outcomes of patients who underwent surgery for fracture fixation of unstable proximal humerus fractures. Inclusion criteria were patients over 50 years old who underwent fixation using intramedullary nails or locking plates (Neer 2- and 3 -parts), from January 2016 to December 2019. Radiological loss of reduction was defined as a decrease of 15 degrees in the neck-shaft angle (NSA) angle on post-operative radiographs, when compared to the immediate post-operative angle. The most prevalent Neer pattern was 3 parts (39.6%), followed by 2 parts (37.4%). Incidence of some degree of reduction loss was 40.2% in the plate group, against 24.8% in the nail group, but not necessarily requiring surgery revision. The incidence of surgery revision was 16.4% (37 revisions), being 13(35%) in the nail group and 24(65%) in the plate group. Neck-shaft angle ranged from 141.3° to 133.3° in the nail group and from 138.4° to 127.9° in the plate group. In this retrospective series of patients over 50 years with displaced unstable proximal humeral fractures, intramedullary nail fixation was superior to locking plate fixation in terms of preventing reduction loss for Neer 2- and 3- parts. Despite the high incidence of some degree of reduction loss, only 16.4% of patients presented failure of fixation, requiring revision surgery.