Comparison between intramedullary nailing and plate fixation in humeral shaft fractures

Humeral shaft fractures are a frequent type of orthopedic injury in adults which can be treated with surgical methods including intramedullary nailing (IMN) or plate fixation (PF). However, despite the wide application of these two methods in clinical practice, it is still being debated which method is superior with respect to operative parameters, fracture healing profile, functional recovery condition and complication rates. The objective of this prospective comparative clinical study was to investigate and compare the clinical, radiological and functional results of IMN and PF for humeral shaft fractures. Two hundred and fifty adult patients aged 18-65 years with acute humeral shaft fracture were identified a assigned for the treatment, and were divided equally into two groups; one group comprising of 125 patient that were treated by IMN and other group of 125 patients treated with plate fixation. Patients were followed up for at least 6 months after operation. Size of incision, blood loss, radiation time and operative time were documented. The assessment of radiological union, time to union, malalignment and complications were recorded through serial follow ups. The functional results were assessed based on the DASH and Constant-Murley scores. Compared with the PF group, IMN was associated for a shorter operative time, lesser blood loss, smaller incision length but greater levels of radiation. Radiographic union rate and time to union did not statistically differ between the groups. Functional results did not differ significantly, but plate fixation was associated with slightly better shoulder function scores, whereas intramedullary nailing enabled earlier resumption of normal activities. Shoulder impingement was predominant in the IMN group, while superficial infection and hardware irritation were slightly higher in the PF group. In conclusion, intramedullary nailing and plate fixation both are effective treatment options with adequate reliability in fractures of the humeral shaft. The selection of the surgical approach should be individualized to fit fracture type, patient requirements and surgeon skill level to obtain optimal results and prevent complications.