Study Finds Intramedullary Nailing Superior to Dual Plating in Selected Shoulder Fractures
China: A new study published in BMC Surgery suggests that intramedullary nailing may offer faster recovery and improved functional outcomes compared with dual-plate fixation in selected patients with proximal humeral fractures. However, the authors emphasize that treatment choice should remain guided by fracture characteristics and bone quality rather than a one-size-fits-all approach.
Proximal humeral fractures are common, particularly among older adults, and can significantly impair shoulder function. Surgical management is often required in displaced or unstable fractures, with commonly used techniques including intramedullary nailing and locking plate fixation. While both methods are widely practiced, evidence comparing their effectiveness in specific clinical scenarios remains limited.
Jianjun Wang from the Department of Orthopedics at Lanzhou First People’s Hospital, Gansu, China, and colleagues conducted a retrospective cohort study to assess outcomes associated with these two surgical strategies. The analysis included 69 patients treated for proximal humeral fractures between October 2022 and August 2024. Of these, 32 patients underwent fixation using a Proximal Humerus Internal Locking System (PHILOS) plate combined with a medial support plate (dual-plate group), while 37 patients received intramedullary nailing. All participants followed a structured early rehabilitation program after surgery.
The researchers compared operative details, duration of hospitalization, fracture healing time, shoulder function scores, and postoperative complications between the two groups. Functional recovery was evaluated using standardized shoulder scores.
The following were the key findings:
- Patients treated with intramedullary nailing had significantly shorter operative times compared to those undergoing dual-plate fixation.
- Hospital stay was significantly shorter in the intramedullary nailing group.
- Intraoperative blood loss was lower among patients who received intramedullary fixation.
- Fracture healing time was shorter in the intramedullary nailing group.
- Both surgical groups showed significant improvement in shoulder function after surgery compared to preoperative status.
- Postoperative shoulder function scores were significantly higher in the intramedullary nailing group than in the dual-plate group, indicating superior short-term functional outcomes.
The authors note that intramedullary nailing appeared particularly advantageous in fractures where medial support was relatively preserved. In contrast, dual-plate fixation continues to play an important role in managing more complex fracture patterns, especially those involving severe medial column deficiency or poor bone quality. Although dual plating was associated with longer surgical time and greater blood loss, it may provide necessary structural stability in challenging cases.
Importantly, the investigators caution against interpreting these findings as proof that intramedullary nailing is universally superior. The retrospective design and indication-based patient selection limit direct generalization. They call for prospective, randomized controlled trials to validate these results and to better define optimal surgical strategies for different fracture patterns.
Overall, the study highlights the importance of individualized treatment planning in proximal humeral fractures, balancing surgical invasiveness with fracture complexity and expected functional recovery.
Reference:
Wang, J., Liang, H., Shi, X. et al. Clinical outcomes of intramedullary nailing and dual-plate fixation for proximal humeral fractures: an indication-based retrospective cohort study. BMC Surg (2026). https://doi.org/10.1186/s12893-026-03540-9
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