A Comparative Study on Locking Plate versus Intramedullary Nail in the Management of Proximal Humerus Fractures

Background: Proximal humerus fractures make up about 5% of all fractures, with a higher occurrence in older adults due to osteoporosis. Non-displaced fractures can be treated with conservative methods, but displaced fractures need surgery. Two main fixation methods, locking plates and intramedullary nails, are commonly used in orthopedic practice, but there is still debate about which is more effective. Locking plates offer better control in the metaphysis with fixed-angle constructs, while intramedullary nails provide biological fixation with less disruption to soft tissue. This study aimed to compare functional outcomes, complication rates, and radiological union between these two techniques in an Indian population. Methods: A prospective comparative cohort study was carried out over 18 months at the Department of Orthopedic Surgery from January 2023 to June 2024. Seventy-five patients with displaced proximal humerus fractures (Neer classification II-IV) were assigned to either locking plate fixation (n=37) or intramedullary nail fixation (n=38). We measured functional outcomes using the Constant-Murley Score and the American Shoulder and Elbow Surgeons (ASES) score at 6 weeks, 3 months, 6 months, and 12 months. Secondary outcomes included the rates of radiological union, complication rates, need for revision surgery, and time to union. We performed statistical analysis with independent t-tests for parametric data, Mann-Whitney U tests for non-parametric data, and Chi-square tests for categorical data (p < 0.05). Results: At 12 months, the mean Constant-Murley score was 76.2±8.4 for the locking plate group and 74.8±9.1 for the intramedullary nail group (p=0.436). The ASES scores were 78.4±7.6 for locking plates and 76.9±8.3 for intramedullary nails (p=0.352). Radiological union was seen in 94.6% of locking plate cases and 92.1% of intramedullary nail cases (p=0.601). Varus collapse occurred in 8.1% of locking plate cases compared to 5.3% for intramedullary nails (p=0.486). Revision surgery was necessary for 5.4% of the locking plate group and 7.9% of the intramedullary nail group (p=0.512). Both groups showed similar functional recovery and acceptable complication rates. Conclusion: Both locking plate and intramedullary nail fixation are effective surgical options for displaced proximal humerus fractures, with similar functional outcomes and complication rates. Treatment should be tailored to the individual, considering fracture complexity, bone quality, and the surgeon's expertise. These results support using both techniques as primary surgical options in Indian orthopedic practice, providing evidence-based outcomes that facilitate a return to daily activities and work