Abstract:

Background

Although proximal humeral fractures combined with ipsilateral humeral shaft fractures are rare， in recent years， with the increase of high-energy injuries， the incidence rate has been increasing yearly and can account for 1%-2% of all humeral fractures. Due to its multiple and complex fractures， there are many difficulties in its treatment， and factors such as intraoperative reduction， selection of internal fixation， and functional rehabilitation exercises need to be considered.Traditional treatment mainly adopts conservative treatment， which has a long fixation time and is prone to complications such as nonunion of fractures and joint stiffness. Therefore， more and more patients are adopting surgical internal fixation treatment. Currently， intramedullary nails （IMN） and locking plate osteosynthesis（LPO）may be considered for the fixation of proximal humeral fractures combined with humeral shaft fractures. LPO can provide stable fixation and has strong angular stability. However， the surgery requires extensive dissection of soft tissues and disruption of the periosteal blood supply， which may lead to delayed healing or nonunion of fractures. Although IMN reduces soft tissue dissection injury and enables early weight-bearing activities， its disadvantages include rotator cuff damage and unstable rotation.

Objective

To compare the efficacy of intramedullary nails and locking plates in treating proximal humeral fractures combined with humeral shaft fractures was clarified.

Methods

Based on the inclusion and exclusion criteria， a retrospective analysis was conducted on the clinical data of 41 cases of proximal humeral fractures combined with ipsilateral brachial shaft fractures admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2024. They were divided into the intramedullary nail treatment group （IMN） and the locking plate treatment group（LPO） according to different fixation methods. The operation time， surgical bleeding， incision length，fracture healing time， Constant-murley score（CMS）， and the disabilities of the arm， shoulder，and hand score（DASH） were evaluated.

Results

The average operation time of the LPO group was（92.25±16.18）min， and that of the IMN group was （96.43±22.98）min. The two groups had no statistically significant difference （t=0.670， P=0.507）. The average surgical blood loss in the LPO group was （176.75±91.14）ml， and that in the IMN group was （107.86±26.39）ml. The IMN group was significantly better than the LPO group （t=3.253， P=0.004）. The average incision length of the LPO group was （17.90±4.28）cm， and that of the IMN group was（7.67±0.73）cm. The IMN group was significantly better than the LPO group （t=10.803， P=0.000）. The average fracture healing time in the LPO group was （13.85±1.79）weeks， and that in the IMN group was （12.67±1.24）weeks.The IMN group was significantly better than the LPO group （t=2.476， P=0.018）. The average CMS score of the LPO group was （86.65±6.91）points， and that of the IMN group was（88.29±6.87）points. The two groups had no statistically significant difference （t=0.760， P=0.452）.The average DASH score of the LPO group was （16.00±6.36）points， and that of the IMN group was（12.57±5.11）points. There was no statistically significant difference between the two groups （t=1.909，P=0.064）.

Conclusion

Both LPO and IMN can be used as effective measures for treating proximal humeral fractures combined with ipsilateral humeral shaft fractures. However， IMN shows obvious advantages in reducing surgical bleeding， shortening surgical incision length， and fracture healing time.

Key words: Proximal humeral fractures, Humeral shaft fractures, Multiple fractures, Intramedullary nail, Locking plate, Constant-Murley score, The disabilities of the arm, shoulder, and hand score