Comparison of minimally invasive plate osteosynthesis and intramedullary nailing in the treatment of surgical neck fractures of the humerus in elderly patients

Proximal humerus fractures are common osteoporotic fractures in the elderly population, presenting challenges in treatment due to differences between surgical options. Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary Nailing (IMN) are the primary techniques employed for managing these fractures, each offering distinct advantages and limitations. This retrospective study evaluated 56 patients aged 50 years or older who were treated for proximal humeral surgical neck fractures between 2018 and 2022. Locked plates were applied using the minimally invasive MIPO technique, while IMN was performed to enhance biomechanical stability. Patients were assessed for functional recovery (DASH scores), pain (VAS scores), and complication rates. The IMN group demonstrated superior functional outcomes with significantly lower DASH scores. Although pain scores were lower in the MIPO group, the difference was not statistically significant. Radiographic healing times were similar between the two groups, but the complication rate was higher in the MIPO group (12.% vs. 4.3%). While IMN appears to provide better functional outcomes, MIPO offers advantages in pain management and patient comfort due to its minimally invasive nature. However, the higher complication rates observed with MIPO warrant attention. Both IMN and MIPO are effective options for treating proximal humerus fractures in elderly patients. However, IMN is found to be more advantageous in terms of functional recovery and lower complication rates, making it a valuable alternative for specific patient populations.