Displaced humeral shaft fracture: Plating versus intramedullary nailing- A prospective cohort study

Abstract

Background: Displaced humeral shaft fractures are among the most frequent long-bone fractures that often require surgical fixation. However, the optimal surgical method remains controversial. Objectives: This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) with plating versus intramedullary Methods: This prospective cohort study included patients undergoing surgery for displaced humeral shaft fractures at Kashani Hospital, Isfahan, Iran, between 2020 and 2022. Demographic and clinical data were collected. Patients were evaluated postoperatively using the Visual Analogue Scale (VAS), Constant-Murley Score, the Mayo Elbow Performance Index (MEPI), and union time. Complication rates and surgical duration were also recorded. Results: Of 85 patients, 43 received plating and 42 underwent nailing. The plating group had higher rates of infection (superficial: 21.4, deep: 9.5) and nerve damage (23) compared to the nailing group (0 and 3, respectively). Reoperation was required in 9 of plating cases compared to 3 in the nailing group. Shoulder impingement occurred only in the nailing group (33). The nailing group had a shorter operative time (63.8 +/- 8.3 min vs. 94.1 +/- 11.2 min) and a faster fracture union (15.3 +/- 2.2 weeks vs. 18.8 +/- 2.1 weeks). Functional and pain scores showed statistically significant differences, favoring nailing in terms of MEPI, while favoring plating in terms of the Conclusions: Both ORIF with plating and IMN achieved satisfactory outcomes. However, intramedullary nailing may be preferable in patients at high risk of nonunion due to faster recovery and lower complication rates.