Journal Article

Helical plating yields better outcomes than intramedullary nailing or long straight lateral plating for humeral shaft fractures extending to the proximal humerus

Zhang, Xin, Zhu, Yangjun, Wang, Xiaolong, Feng, Dongxu, Qiao, Haifeng, Kang, Xiaomin, Jiang, Yuxuan, Zhang, Yan

2025

Overview

Background This study was performed to compare the operative clinical outcomes of helical plating, intramedullary nailing (IMN), and long straight lateral plating in the treatment of humeral shaft fractures extending into the proximal humerus, as well as to identify the optimal fixation strategy for managing such injuries. Methods In total, 81 patients with humeral shaft fractures extending into the proximal humerus were divided into three groups based on treatment strategy: helical plating (Group A, n  = 16), IMN (Group B, n  = 12), and long straight lateral plating (Group C, n  = 53). Preoperative demographic data and imaging were collected from the medical records. Operative time, blood transfusion, bone reduction quality, bone healing rate, and incidence of complications were recorded. Clinical evaluation included the Constant–Murley score for shoulder function, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for upper limb function, the visual analogue scale (VAS) for pain, and assessments of shoulder stiffness or instability and patient satisfaction. Results Compared with Groups A and C, patients in Group B had a longer operative time and lower blood transfusion requirements. More than 80% of patients in each group achieved bone reduction quality rated as “better than good.” There were no significant differences among the three groups in operative time, blood transfusion, or shaft angulation. Bone healing rates were 100%, 91.7%, and 94.3% in Groups A, B, and C, respectively. Mean shoulder flexion was 155.0°, 130.0°, and 150.0°, respectively. Functional outcomes, including the Constant–Murley score, DASH score, VAS score, and patient satisfaction, were significantly better in Group A than in Groups B and C. No complications occurred in Group A. One patient in Group B developed nonunion. In Group C, complications were observed in five patients (9.4%). Conclusion In the treatment of humeral shaft fractures extending into the proximal humerus, helical plating was associated with a higher bone union rate, better functional outcomes, and a lower postoperative complication rate compared with IMN or long straight lateral locking plates. Outcomes after nailing and long straight lateral plating were similar.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Antibiotics / Arm / Blood transfusion / Bone healing / Bone imaging / Bone Nails / Bone Plates / Bone surgery / Care and treatment / Complications / Female / Fracture Fixation, Internal - instrumentation / Fracture Fixation, Internal - methods / Fracture Fixation, Intramedullary - instrumentation / Fracture Fixation, Intramedullary - methods / Fracture Healing / Fractures / Helical plating / Humans / Humeral Fractures - diagnostic imaging / Humeral Fractures - surgery / Humeral shaft fractures extending to the proximal humerus / Humerus / Injuries / Internal fixation in fractures / Intramedullary nailing / Long straight lateral plating / Male / Medical records / Medicine / Medicine & Public Health / Middle Aged / Neurological disorders / Nonunion / Open reduction and internal fixation / Orthopedics / Patient outcomes / Patient satisfaction / Patients / Postoperative / Retrospective Studies / Rotator cuff / Shoulder / Shoulder Fractures - diagnostic imaging / Shoulder Fractures - surgery / Surgeons / Surgical Orthopedics / Treatment Outcome / Visual perception / X-rays / Young Adult