Comparative study between locking plates versus proximal humeral nail for the treatment of 2-part proximal humeral fractures

The aim of this study is to compare the functional and radiological results of Philos plate and NHP-T2 nail for the treatment of displaced 2-part proximal humeral fractures. Between May 2005 and June 2006, we operated 29 2-part humeral fractures. The selection of the implant was not randomized, but it was surgeon choice. There were 15 patients operated with the NHP-T2 nail (group A) and 14 patients with the Philos plate (group B). There were no statistical differences between the preoperative data of the two groups: mean age, sex distribution, level of activity, mechanism of injury, type of fracture, associated fractures, or the hematocrit levels. The patients were assed clinically and radiologically months after surgery. At 1-year follow-up, an independent evaluator additionally determined the Constant and Oxford scores. All fractures except one healed in the first 3 months. In group A, there was one delayed union that healed at 4 months. There were 2 malunion cases in each group. No case of avascular necrosis of the humeral head was observed. There were no statistical differences between the functional results of the implants. We had more patients who required blood transfusion in group B and more fractures of the entry point and implant removal in the group A. The consolidation rate and functional results are similar in both groups, with no statistical significance. The complications appeared seemed to be approach related and did not influence the final results. An accurate technique and sufficient experience are needed to achieve a correct reduction and fixation.