Outcomes of intramedullary nailing versus plate fixation for humeral shaft fractures: a retrospective cohort study

Abstract

BACKGROUND: Humeral shaft fractures account for 1-3% of all bone fractures. Conservative treatment often leads to complications such as non-union and shoulder stiffness. Surgical fixation with a dynamic compression plate (DCP) has been the gold standard treatment. Intramedullary nailing (IMN) has recently gained popularity due to its minimally invasive approach and reduced risk of radial nerve injury. This study aims to compare the outcomes of IMN and plate fixation for humeral shaft fractures. METHODS: This retrospective study included patients with humeral shaft fractures treated with either IMN or DCP fixation at Hamad General Hospital between April 2015 and October 2018. Patient demographics, fracture characteristics, surgical outcomes, and complications were collected. Descriptive statistics were used to summarize patient information, and univariate analysis was conducted to compare both groups. A Cox proportional hazards model, adjusted for age, gender, and polytrauma status was applied to compare time to union between IMN and DCP groups. RESULTS: Sixty five patients (25 IMN, 40 plate fixation) were included. Non-union rates were higher in the DCP group than in the IMN group (13% vs. 4%). Reoperation rates were also higher in the DCP group (20% vs. 4%). Postoperative neuropathy rates were 4% for IMN and 10% for DCP, with neuropathy resolution significantly higher in the IMN group (92% vs. 68%). Shoulder range of motion (ROM) and pain favored the DCP group, with 98% unaffected ROM in the plate group compared to 76% in the IMN group (p = 0.007), and a lower incidence of shoulder pain (28% vs. 98%, p < 0.001). Time to union was comparable between both groups, with an adjusted hazard ratio of 1.08 (95% CI 0.62-1.90; p = 0.776). CONCLUSION: IMN and plate fixation effectively achieved fracture union; however, plate fixation was associated with better shoulder function, reduced pain, and higher reoperation rates. IMN was linked to a lower risk of nerve injury but compromised shoulder ROM and resulted in more postoperative pain.