Surgical Duration Drops With Intramedullary Nails Compared to Locking Plates
A mean operative time of 75.43 minutes for proximal humeral nailing stands against 111.93 minutes for PHILOS plating, according to a prospective comparative study. The study tracked 60 patients with displaced two-part or three-part proximal humerus fractures treated between February 9, 2025, and September 23, 2025, at Government Medical College and Rajindra Hospital in Patiala, Punjab, India. While operating times favored nails, a broader observational study of 211 patients reported that patients in the proximal humeral nail group perceived significantly less pain at 3, 6, and 12 months after surgery than those treated with plate fixation.
Blood Loss and Perioperative Metrics in Fracture Fixation
Estimated blood loss averaged 132.33 mL in the nail cohort compared to 201.67 mL in the plate cohort. The study protocol received approval from the Institutional Ethics and Research Committee at Government Medical College in Patiala under approval number Trg.8(109) 2025/44231-276. Despite the differences in operative duration and blood loss, functional recovery scores showed convergence over time.
Constant-Murley Functional Scores at Twelve Months
Constant-Murley scores increased across both treatment groups over the 12-month follow-up period. A linear mixed-effects model revealed no statistically significant group-by-time interaction, though the estimated score difference at 12 months stood at 2.60 points favoring nails. Mean time to fracture union showed no significant difference, measuring 15.23 weeks for nails and 15.53 weeks for plates. Each group experienced two complications, resulting in an overall complication rate of 6.7 percent across the 60 patients.
Surgical Skill Dictates Success in Proximal Humerus Fracture Repairs
Broader clinical evaluations indicate that advanced surgical skills and experience matter more for successful outcomes in three-part proximal humerus fractures than the choice of implant itself. Many local and intraoperative complications stem from surgical technique rather than hardware selection. Both intramedullary nailing and locking plate fixation remain established options for managing unstable fractures, though each carries distinct technical considerations, including rotator-cuff and soft-tissue concerns.
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