Clinical outcomes of intramedullary nailing and dual-plate fixation for proximal humeral fractures: an indication-based retrospective cohort study

To evaluate the clinical outcomes of intramedullary nailing and dual-plate fixation for the treatment of proximal humeral fractures in an indication-based retrospective cohort. A retrospective analysis was conducted on 69 patients with proximal humeral fractures admitted to our hospital from October 2022 to August 2024. Among them, 32 patients underwent fixation using Proximal humerus internal locking system (Philos) combined with a medial support plate (dual-plate group), while 37 patients underwent intramedullary nailing (intramedullary nailing group). All patients received early systematic rehabilitation therapy. Surgical parameters, hospital stay, fracture healing time, shoulder function scores, and postoperative complications were compared between the two groups. The intramedullary nailing group had shorter operative time, hospital stay, and fracture healing time compared to the dual-plate group (P < 0.05). The intraoperative blood loss was also lower in the intramedullary nailing group (P < 0.05). Postoperatively, the shoulder function scores in both groups improved significantly compared to preoperative values (P < 0.05), with significantly higher scores in the intramedullary nailing group than in the dual-plate group (P < 0.05). In this indication-based retrospective cohort, intramedullary nailing was associated with shorter operative time, less intraoperative blood loss, faster fracture healing and better shoulder function scores than double plating in proximal humeral fractures with relatively preserved medial support. Double-plate fixation remains an important option for complex fractures with severe medial column deficiency and poor bone quality, despite greater surgical trauma. These findings should not be interpreted as evidence that intramedullary nailing is superior for all proximal humeral fractures, and prospective randomized studies are needed to confirm the results.