Functional and clinical outcome after plate osteosynthesis versus intramedullary nailing of a humeral shaft fracture (HUMMER): Results of a multicenter prospective cohort study

Abstract text (incl. references and figure legends)

Introduction: Plate osteosynthesis and intramedullary nailing (IMN) are the most common operative strategies for humeral shaft fractures. However, the most effective treatment is undecided. The aim of this study was to compare functional and clinical outcome of these treatment strategies in adults with a humeral shaft fracture. We hypothesized that plate osteosynthesis would result in earlier recovery of shoulder function and fewer complications.

Methods: From October 23, 2012 to October 03, 2018, adults with a humeral shaft fracture AO type 12A or 12B were enrolled in a multicenter prospective cohort study. Patients were treated with a plate or an IMN. Outcome measures included the Constant-Murley score, range of motion (ROM) of the shoulder and elbow joint, radiologic healing, and complications. Patients were followed for one year. Repeated measure analysis was done with correction for age, gender, and fracture type.

Results: Of the 245 included patients, 76 were treated with a plate and 169 with an IMN. Patients in the plate group were younger (median 43 versus 57 years; p<0.001). The Constant-Murley score and shoulder abduction, flexion, external rotation, and internal rotation all displayed a significant treatment effect with a ptreatment≤0.001, in favor of plating. The plate group had only two implant-related complications, whereas the IMN group showed 13 nail protrusions and eight screw protrusions. Compared with nailing, plating resulted in more post-operative temporary radial nerve palsy (N=8; 10.5% versus N=1; 0.6%; p<0.001). Nonunion occurred more frequently after nailing (N=16; 11.9%) than after plating (N=3; 5.7%; p=0.285).

Conclusions: Plating of a humeral shaft fracture in adults results in faster recovery, especially of the shoulder function. Since it was also associated with fewer implant-related complications and surgical reinterventions than nailing, plating should be the preferred treatment option for these fractures.

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All authors declare: DDH and EMMVL had financial support from the OTC Foundation for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.