Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (36): 5782-5786.doi: 10.12307/2021.342

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Intramedullary nail versus shoulder hemiarthroplasty for proximal humeral fractures with varus deformity: a retrospective non-random small-sample advantage analysis

Wang Qingwei1, Wang Huasong2, Huang Jifeng2, Shi Huafeng1, Hu Shouyong1, Xie Hui1   

  1. 1Department of Orthopedics, the First People’s Hospital of Jingmen, Jingmen 448000, Hubei Province, China; 2Department of Orthopedics, General Hospital of Central Theater Command, Wuhan 430070, Hubei Province, China
  • Received:2021-02-25 Revised:2021-02-26 Accepted:2021-03-31 Online:2021-12-28 Published:2021-09-17
  • Contact: Wang Huasong, MD, Associate chief physician, Master’s supervisor, Department of Orthopedics, General Hospital of Central Theater Command, Wuhan 430070, Hubei Province, China
  • About author:Wang Qingwei, Master, Physician, Department of Orthopedics, the First People’s Hospital of Jingmen, Jingmen 448000, Hubei Province, China
  • Supported by:
    Jingmen Municipal Science and Technology Research and Development Project, No. 2020YFYB085 (to WQW)

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Abstract: ACKGROUND: Early surgical treatments, mainly including internal fixation and joint replacement, are favored for unstable or significantly displaced proximal humeral fractures in clinical practice. However, there is still a controversy on the specific regimen for elderly osteoporotic patients.  
OBJECTIVE: To compare the clinical outcomes of Trigen intramedullary nailing versus shoulder hemiarthroplasty for varus proximal humeral fractures.
METHODS:  A retrospective study was performed on 54 patients with varus proximal humerus fractures treated with intramedullary nailing or shoulder hemiarthroplasty in the General Hospital of Central Theater Command from January 2016 to January 2019. There were 22 males and 32 females. According to the different treatment methods, all the patients were divided into two groups: 35 patients in the intramedullary nail group and 19 patients in the shoulder hemiarthroplasty. Operation time, intraoperative blood loss, length of hospital stay and shoulder joint mobility, Visual Analogue Scale score, Constant-Murley shoulder joint score, and complications at the last follow-up were recorded and compared between two groups.  
RESULTS AND CONCLUSION: There was no significant difference in the preoperative data between the intramedullary nail group and the shoulder hemiarthroplasty group (P > 0.05), and they were comparable. The operation time of the intramedullary nail group [(59.6±14.3) minutes] was significantly shorter than that in the shoulder hemiarthroplasty group [(95.7±17.2) minutes] (P < 0.05). The intraoperative blood loss in the intramedullary nail group [(78.5±18.9) mL] was significantly lower than that in the shoulder hemiarthroplasty group [(203.7±23.1) mL] (P < 0.05). There were no significant differences in hospitalization time and follow-up time between the two groups (P > 0.05). The intramedullary nail group was superior to the shoulder hemiarthroplasty group in shoulder mobility and Constant-Murley shoulder joint score at the last follow-up, and the differences were statistically significant (P < 0.05). There were no significant differences in Visual Analogue Scale score and complications at the last follow-up between the two groups (P > 0.05). To conclude, both intramedullary nail and shoulder hemiarthroplasty are effective surgical procedures for proximal humeral fracture with varus deformity. Intramedullary nailing is more invasive, with better recovery of shoulder function.

Key words: proximal humeral fracture, intramedullary nailing, internal fixation, shoulder hemiarthroplasty, varus deformity

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