Boadi Prince J, Da Silva Adrik, Mizels Josh, Joyce Christopher D, Anakwenze Oke A, Klifto Christopher S, Chalmers Peter N
Duke University School of Medicine, Durham, NC, USA.
University of Utah School of Medicine, Salt Lake City, UT, USA.
JSES Rev Rep Tech. 2024 Feb 4;4(3):615-624. doi: 10.1016/j.xrrt.2024.01.001. eCollection 2024 Aug.
The incidence of proximal humerus fractures (PHFs) continues to increase with an aging population, and intramedullary nailing (IMN) and locking plate fixation are two commonly employed techniques for the surgical management of PHF. However, the optimal fixation method can be a source of ongoing controversy. Some influencing factors include the extent of humeral head involvement, fracture complexity, patient age, and surgeon preference. There are many studies that provide a mix of data either when comparing the two techniques or analyzing them in isolation. The aim of this review is to further elucidate the indications and technical considerations involved specifically in IMN vs. locking plate fixation for PHF to further aid orthopedic surgeons when choosing surgical management.
A narrative approach was chosen for this review allowing for a comprehensive review of literature, including recent findings pertaining to the comparison of management options for PHF. A comprehensive literature search was conducted using the PubMed, Embase, and Cochrane Library databases. The inclusion criteria involved studies that discussed "proximal humerus fracture" and either "intramedullary nail" or "locking plate fixation."
Complications such as avascular necrosis, hardware failure, additional surgical interventions, infection, fracture redisplacement, rotator cuff rupture, and nonunion did not show significant differences between the two groups. Newer generation humeral nails have minimized early complications. As both techniques undergo further refinement and utilization when specifically indicated, functional outcomes, potential complications, and postoperative pain continue to be improved.
The available evidence suggests that both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method. The choice of technique should be tailored to patient factors such as fracture type, age, bone quality, and functional expectations. Surgeon experience also plays a role. While certain presentations may exhibit trends that favor one fixation, no specific technique can be universally recommended. Both IMN and LP have shown comparable and satisfactory outcomes, and the final fixation method chosen should take into account the unique characteristics of each patient.
随着人口老龄化，肱骨近端骨折（PHF）的发病率持续上升，髓内钉固定（IMN）和锁定钢板固定是PHF手术治疗中常用的两种技术。然而，最佳固定方法一直存在争议。一些影响因素包括肱骨头受累程度、骨折复杂性、患者年龄和外科医生的偏好。有许多研究在比较这两种技术或单独分析它们时提供了混合数据。本综述的目的是进一步阐明IMN与锁定钢板固定治疗PHF所涉及的适应症和技术要点，以在选择手术治疗时进一步帮助骨科医生。
本综述采用叙述性方法，以便对文献进行全面回顾，包括有关PHF治疗方案比较的最新研究结果。使用PubMed、Embase和Cochrane图书馆数据库进行了全面的文献检索。纳入标准包括讨论“肱骨近端骨折”以及“髓内钉”或“锁定钢板固定”的研究。
两组之间在缺血性坏死、内固定失败、额外手术干预、感染、骨折再移位、肩袖破裂和骨不连等并发症方面没有显著差异。新一代肱骨钉已将早期并发症降至最低。随着这两种技术在特定适应症下进一步完善和应用，功能结果、潜在并发症和术后疼痛都在不断改善。
现有证据表明，髓内钉和锁定钢板在治疗移位肱骨近端骨折时均可有效恢复肩部功能，两种方法的优势尚不明确。技术选择应根据患者因素进行调整，如骨折类型、年龄、骨质和功能期望。外科医生的经验也起着重要作用。虽然某些表现可能显示出有利于一种固定方式的趋势，但没有一种特定技术可以被普遍推荐。IMN和LP都显示出相当且令人满意的结果，最终选择的固定方法应考虑每个患者的独特特征。
