Intramedullary Nails vs. Locking Plates for Displaced Proximal Humerus Fractures in Patients over 60: A Comparative Clinical Study

<b>Background:</b> Displaced proximal humerus fractures (PHFs) in adults represent a common orthopedic challenge, especially in elderly patients with compromised bone quality. Intramedullary nails (IM) and locking plates (LP) are the most widely used fixation techniques, though the literature remains inconclusive regarding their comparative efficacy. <b>Methods:</b> This retrospective cohort study included 187 patients (mean age: 65.4 years) treated surgically for Neer ≥ 2-part proximal humerus fractures at a single tertiary referral center between 2018 and 2023. Patients underwent either IM nailing or LP fixation. Baseline characteristics included age, sex, smoking status, ASA score, trauma mechanism, and bone quality (assessed by the Deltoid Tuberosity Index). Functional outcomes (DASH and Constant-Murley scores), range of motion (ROM), radiographic healing, and complications were evaluated at 1, 3, 6, and 12 months postoperatively. Results were stratified by fracture type (two-, three-, and four-part fractures) and treatment group. <b>Results:</b> At 12 months, no statistically significant differences were found between groups in terms of DASH (<i>p</i> = 0.484) or Constant-Murley scores (<i>p</i> = 0.057). ROM recovery was comparable across all time points. Stratified analysis showed similar outcomes across fracture types. Age, smoking, and bone quality did not significantly influence clinical results. The overall complication rate was 11.8%, with no significant difference between groups. Avascular necrosis and hardware-related issues occurred predominantly in four-part fractures. <b>Conclusions:</b> Both intramedullary nailing and locking plate fixation provided comparable short-term outcomes for displaced PHFs. Functional recovery appeared more dependent on fracture complexity than on the choice of implant. Surgical technique should therefore be selected based on fracture morphology, patient characteristics, and surgeon experience.