Effects of locking compression plate versus intramedullary nail fixation on fracture healing in emergency open humeral fractures

: Open humeral fractures are common severe trauma cases in emergency surgery, and selecting appropriate internal fixation methods is crucial for promoting fracture healing and reducing systemic stress response. This study aims to compare the clinical efficacy of locking compression plate (LCP) and intramedullary nail fixation in treating emergency open humeral fractures, and analyze their effects on fracture healing, stress factors, and inflammatory factors. : A retrospective analysis was conducted on 117 patients with open humeral fractures admitted to the Emergency Department of Cangzhou Central Hospital from January 2020 to December 2023. Patients were divided into LCP group (n=58) and intramedullary nail group (n=59) according to internal fixation methods. Clinical indicators including operative time, intraoperative blood loss, fracture healing time, and complication rates were compared between the two groups. Serum levels of stress factors including cortisol (Cor) and norepinephrine (NE), and inflammatory factors including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) were measured preoperatively, 24 hours postoperatively, and 7 days postoperatively. Mayo elbow performance score was used to evaluate functional recovery. : There were no statistically significant differences in baseline characteristics between the two groups (P>0. 05). The intramedullary nail group showed significantly shorter operative time compared to the LCP group (78. 4±15. 2 min vs 95. 6±18. 7 min, P<0. 01) and markedly reduced intraoperative blood loss (145. 3±32. 8 ml vs 198. 7±45. 6 ml, P<0. 01). Regarding fracture healing time, the intramedullary nail group demonstrated shorter healing time compared to the LCP group (12. 3±2. 1 weeks vs 14. 8±2. 9 weeks, P<0. 01). At 24 hours postoperatively, serum Cor and NE levels in the intramedullary nail group were significantly lower than those in the LCP group (P<0. 05). For inflammatory factors, IL-6, TNF-α, and CRP levels in the intramedullary nail group were all significantly lower than those in the LCP group (P<0. 01). At 12 months postoperatively, the Mayo elbow performance score showed an excellent-good rate of 89. 8% (53/59) in the intramedullary nail group, significantly higher than 75. 9% (44/58) in the LCP group (P<0. 05). The complication rate was 8. 5% (5/59) in the intramedullary nail group, lower than 17. 2% (10/58) in the LCP group, but the difference was not statistically significant (P>0. 05). : In this retrospective study, intramedullary nailing was associated with shorter operative time, less blood loss, and faster time to union compared with locking compression plates; causal inference is limited by the nonrandomized design.