Percutaneous pinning versus plate and screws for proximal humeral fracture. A multicenter prospective study.

ABSTRACT Background and Objectives: Proximal humeral fractures represent approximately 5–6% of all fractures in the general population. They mainly occur in the osteoporotic bones of older individuals and are extensively studied. Although most of these fractures are treated conservatively, multiple surgical options exist. This study aimed to compare two osteosynthesis techniques for treating proximal humeral fractures, specifically percutaneous pinning versus plate and screws. The goal was to evaluate patient characteristics, surgical data, and outcomes to determine whether a particular technique was more effective or if there was a link between specific types of humeral fractures and the procedures that led to better outcomes. Methods: A prospective, non-randomized, multicenter study was conducted. After patients received one of the two treatment options and met the inclusion criteria, each center shared data on the patient’s demographics, surgical details, post-surgical progress, and subsequent ambulatory and radiological follow-ups. Inclusion in the study was determined by a consensus of over 70% among the participating centers on the same surgical treatment. The assessment scores used during follow-ups were SSV, OSS, and QuickDASH. Patients were then divided into the two treatment groups and matched based on fracture type, age, sex, and percentage of inclusion accordance. Results: The study population was predominantly elderly, with those treated by fixator being on average 7.87 years older than those receiving plate (p<0.01). Patients in the plates group were younger, notably within the VPM and DN fracture categories (p=0.023). Females represented the majority (3:1 ratio), and most fractures involved the dominant side. Surgery duration decreased with age (p=0.001) and varied by fracture type, showing longer plate durations in the different subtypes. Regarding in-hospital stays, the fixator group had significantly fewer nights (1.347 fewer nights, p=0.013). In contrast, the plate group remained hospitalized longer, with a significant finding in the VPM and VPM-GT fracture types (p<0.05). Patients experiencing complications were 42.6% more likely to stay additional nights (p=0.024). An ASA 2 score was the most common overall. Functional outcomes were favorable, with higher SSV, OSS, and QuickDASH scores at 12 months compared to previous follow-ups. Among the plate group, older patients had significantly lower OSS scores at 12 months (p=0.041). Complications were rare: pain was more frequent at 3 months (and more prevalent in the fixator group), stiffness and late consolidation were noted at 6 months, and stiffness and necrosis at 12 months (both higher in the plate group). Fracture type influenced outcomes: at 3 months, fixators showed better SSV for DN fractures (p=0.008), whereas plates had superior SSV and QuickDASH scores for VL-GT fractures (p=0.043 and p=0.037, respectively). Conclusions: The study highlights the roles of age, potential complications, and fracture type as key factors influencing treatment decisions and subsequent recovery. Notable differences between fixators and plates were observed in terms of surgery duration, hospital stay, complication profiles, and functional outcomes, emphasizing the necessity of individualized decision-making in managing proximal humeral fractures.