Various operative treatments have been proposed for proximal humeral fractures.

The purpose of our study was to compare complications of plate versus nail for these proximal humeral fractures and to determine whether it is the implant or fracture and surgeon related factors which result in complications.

We had 74 patients operated from March 2006 till June 2008 for displaced 3 (49pts) or 4 (25pts) part proximal humeral fractures. 43 had plating (PHILOS) and 31 had a humeral nail inserted. 57 patients were over 60 years at presentation while 17 were younger than 60. All patients were followed regularly radiologically. The functional outcomes were assessed by Quick DASH score and were comparable in both groups at 1 year postoperatively.18 of the 43 patients in the Plating group had a radiological complication with 9 cases of screw cut-out, 5 fractures maluniting and 1 nonunion. There was no case of osteonecrosis. In the nailing group, 13 patients had radiological complications, with 8 patients having varus malunion, 3 having proximal screw loosening and 1 having osteonecrosis apart from the clinical complications of impingement and rotator cuff problems.

Given the similar complication rate and similar functional outcome achieved by both these techniques it is hard to determine if any one in particular is better than the other. The key determining factors for a proximal humeral fracture might actually be patient and surgeon related. It is important to achieve medial continuity and good initial reduction in these fractures to prevent them from collapsing into varus, especially with the nails. Also, patient age, osteoporosis and functional demand are factors determining success of surgery in these patients. We did not find the severity of the fracture to be a determining factor, maybe this was because the relative proportion of type 4 fractures in our series was less.