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Background <p>Proximal humerus fractures (PHFs) are common fragility injuries in elderly patients. Surgical fixation is often indicated for displaced fractures, with locking plates and intramedullary nails being the most widely used implants. While both techniques are established, their relative efficacy and safety in the elderly remain debated.</p> Methods <p>A systematic search was conducted in PubMed, Scopus, Cochrane Library, and Google Scholar through October 2025. Ten comparative studies involving patients older than 60 years met the inclusion criteria. Extracted outcomes included perioperative parameters (operative time, blood loss), healing-related outcomes (union time, neck-shaft angle), pain (VAS), functional scores (ASES, Constant), shoulder range of motion, complications (avascular necrosis, infection, fixation failure, frozen shoulder, implant-related problems), and reoperation rates (total and hardware removal).</p> Results <p>Intramedullary nails were associated with significantly reduced operative time (MD = 14.15&#xa0;min, <i>p</i> &lt; 0.001) and blood loss (MD = 34.55 mL, <i>p</i> = 0.005) compared with plates. Nails also demonstrated lower VAS pain scores at &lt; 1 year (MD = 0.42, <i>p</i> &lt; 0.001), though no difference persisted at ≥ 1 year (<i>p</i> &gt; 0.05). A small short-term advantage in Constant scores was observed in favor of plates (MD = 12.82, <i>p</i> = 0.04), but this effect did not remain at longer follow-up (<i>p</i> &gt; 0.05). No significant differences were found between groups in union time, neck-shaft angle restoration, shoulder range of motion, ASES scores, long-term complications, total reoperation rates, or hardware removal rates (<i>p</i> &gt; 0.05).</p> Conclusions <p>Intramedullary nails provide modest perioperative and early pain-related benefits compared with plates in elderly patients with PHFs, while plating may offer a minor short-term functional advantage. Overall, both techniques achieve comparable long-term outcomes in healing, function, and safety. Implant selection should therefore be individualized according to fracture characteristics, patient comorbidities, and surgeon expertise.</p>

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Locking plates versus intramedullary nails for the treatment of two- and three-part proximal humerus fractures in patients older than 60 years: a meta-analysis

  • 期刊论文

  • 发表日期：

    2025年12月15日

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  • Joe Azar,
  • Guy Awad,
  • Marc Boutros,
  • Raphael Asmar,
  • Zayan Safi,
  • Bassem Elhassan

摘要

Background

Proximal humerus fractures (PHFs) are common fragility injuries in elderly patients. Surgical fixation is often indicated for displaced fractures, with locking plates and intramedullary nails being the most widely used implants. While both techniques are established, their relative efficacy and safety in the elderly remain debated.

Methods

A systematic search was conducted in PubMed, Scopus, Cochrane Library, and Google Scholar through October 2025. Ten comparative studies involving patients older than 60 years met the inclusion criteria. Extracted outcomes included perioperative parameters (operative time, blood loss), healing-related outcomes (union time, neck-shaft angle), pain (VAS), functional scores (ASES, Constant), shoulder range of motion, complications (avascular necrosis, infection, fixation failure, frozen shoulder, implant-related problems), and reoperation rates (total and hardware removal).

Results

Intramedullary nails were associated with significantly reduced operative time (MD = 14.15 min, p < 0.001) and blood loss (MD = 34.55 mL, p = 0.005) compared with plates. Nails also demonstrated lower VAS pain scores at < 1 year (MD = 0.42, p < 0.001), though no difference persisted at ≥ 1 year (p > 0.05). A small short-term advantage in Constant scores was observed in favor of plates (MD = 12.82, p = 0.04), but this effect did not remain at longer follow-up (p > 0.05). No significant differences were found between groups in union time, neck-shaft angle restoration, shoulder range of motion, ASES scores, long-term complications, total reoperation rates, or hardware removal rates (p > 0.05).

Conclusions

Intramedullary nails provide modest perioperative and early pain-related benefits compared with plates in elderly patients with PHFs, while plating may offer a minor short-term functional advantage. Overall, both techniques achieve comparable long-term outcomes in healing, function, and safety. Implant selection should therefore be individualized according to fracture characteristics, patient comorbidities, and surgeon expertise.