{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T09:35:59Z","timestamp":1776332159994,"version":"3.50.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005758","name":"Universit\u00e0 Politecnica delle Marche","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005758","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Musculoskelet Surg"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Proximal humeral fractures (PHFs) are fairly common injuries, and their treatment is a challenge. The aim of this study is to compare clinical and functional outcomes of different osteosynthesis techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We retrospectively reviewed patients\u2019 files and the hospital\u2019s digital database between March 2002 and April 2018. We treated surgically 148 patients with 2- and 3-part PHFs: 64 with plate and screws, 53 with intramedullary nailing and 31 with retrograde<jats:italic>K<\/jats:italic>-wires. We constituted three groups according to the type of treatment and two subgroups for each according to the number of fragments (Neer II or Neer III). Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-12 (SF-12) scores were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean DASH and SF-12 scores both from the group treated with plate (Group I) and the one subjected to intramedullary nailing (Group II) were statistically superior to results from the patients treated by retrograde<jats:italic>K<\/jats:italic>-wires (Group III), while nails showed better functional results than the locking plates. In the first two groups, no difference was found between Neer II and III subgroups, while in Group III the DASH scores were significantly better in Neer II subgroup than those in Neer III subgroup. Avascular necrosis was the most frequent cause of revision surgery in Group I (4 cases) where we had 8 cases of reintervention (12.5%). In Group II, the subacromial impingement was the only cause for revision surgery with 3 cases (5.6%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Intramedullary nails showed better functional results and a lower complication rate than the locking plates. Both techniques showed superior results compared to those available with retrograde<jats:italic>K<\/jats:italic>-wires. So the nail seems to be a more reliable and adequate method for treating 2- and 3-part proximal humeral fractures.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s12306-020-00686-4","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T17:25:03Z","timestamp":1606757103000},"page":"163-167","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Surgical management of 2- or 3-part proximal humeral fractures: comparison of plate, nail and K-wires"],"prefix":"10.1007","volume":"106","author":[{"given":"N.","family":"Setaro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Rotini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8471-7919","authenticated-orcid":false,"given":"P.","family":"Luciani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Facco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Gigante","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"686_CR1","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/BF01623273","volume":"3","author":"JB Lauritzen","year":"1993","unstructured":"Lauritzen JB, Schwarz P, Lund B, McNair P, Transb\u00f8l I (1993) Changing incidence and residual lifetime risk of common osteoporosis-related fractures. Osteoporos Int 3:127\u2013132","journal-title":"Osteoporos Int"},{"key":"686_CR2","doi-asserted-by":"publisher","first-page":"837","DOI":"10.7326\/0003-4819-115-11-837","volume":"115","author":"DG Seeley","year":"1991","unstructured":"Seeley DG et al (1991) Which fractures are associated with low appendicular bone mass in elderly women? The study of osteoporotic fractures research group. Ann Intern Med 115:837\u2013842","journal-title":"Ann Intern Med"},{"key":"686_CR3","doi-asserted-by":"publisher","first-page":"42","DOI":"10.5435\/JAAOS-D-15-00240","volume":"25","author":"VK Kancherla","year":"2017","unstructured":"Kancherla VK, Singh A, Anakwenze OA (2017) Management of acute proximal humeral fractures. J Am Acad Orthop Surg 25:42\u201352","journal-title":"J Am Acad Orthop Surg"},{"key":"686_CR4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd000434.pub2","author":"HH Handoll","year":"2010","unstructured":"Handoll HH, Ollivere BJ (2010) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.cd000434.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"686_CR5","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.jse.2013.07.044","volume":"23","author":"PN Chalmers","year":"2014","unstructured":"Chalmers PN et al (2014) Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elbow Surg 23:197\u2013204","journal-title":"J Shoulder Elbow Surg"},{"key":"686_CR6","doi-asserted-by":"publisher","DOI":"10.1007\/s12306-019-00610-5","author":"S Congia","year":"2019","unstructured":"Congia S, Palmas A, Marongiu G, Capone A (2019) Is antegrade nailing a proper option in 2- and 3-part proximal humeral fractures? Musculoskelet Surg. https:\/\/doi.org\/10.1007\/s12306-019-00610-5","journal-title":"Musculoskelet Surg"},{"key":"686_CR7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.jse.2018.06.034","volume":"28","author":"S Gumina","year":"2019","unstructured":"Gumina S et al (2019) Complex humeral head fractures treated with blocked threaded wires: maintenance of the reduction and clinical results with two different fixation constructs. J Shoulder Elbow Surg 28:36\u201341","journal-title":"J Shoulder Elbow Surg"},{"key":"686_CR8","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1097\/01.blo.0000198718.91223.ca","volume":"442","author":"CS Neer","year":"2006","unstructured":"Neer CS (2006) Displaced proximal humeral fractures: part I. Classification and evaluation 1970. Clin Orthop Relat Res 442:77\u201382","journal-title":"Clin Orthop Relat Res"},{"issue":"Suppl 2","key":"686_CR9","doi-asserted-by":"publisher","first-page":"S65","DOI":"10.1007\/s00198-004-1714-2","volume":"16","author":"R Hertel","year":"2005","unstructured":"Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16(Suppl 2):S65\u2013S72","journal-title":"Osteoporos Int"},{"key":"686_CR10","doi-asserted-by":"publisher","first-page":"121","DOI":"10.2106\/JBJS.I.01505","volume":"93","author":"J-E Bell","year":"2011","unstructured":"Bell J-E et al (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am 93:121\u2013131","journal-title":"J Bone Joint Surg Am"},{"key":"686_CR11","doi-asserted-by":"publisher","DOI":"10.1007\/s12306-020-00669-5","author":"P Luciani","year":"2020","unstructured":"Luciani P, Procaccini R, Rotini M, Pettinari F, Gigante A (2020) Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient. Musculoskelet Surg. https:\/\/doi.org\/10.1007\/s12306-020-00669-5","journal-title":"Musculoskelet Surg"},{"key":"686_CR12","doi-asserted-by":"publisher","first-page":"6451849","DOI":"10.1155\/2016\/6451849","volume":"2016","author":"R Bogner","year":"2016","unstructured":"Bogner R et al (2016) Minimally invasive treatment of displaced proximal humeral fractures in patients older than 70\u00a0years using the humerusblock. Biomed Res Int 2016:6451849","journal-title":"Biomed Res Int"},{"key":"686_CR13","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1055\/s-0030-1249919","volume":"148","author":"H Lill","year":"2010","unstructured":"Lill H, Voigt C (2010) Proximal humeral fracture. Z Orthop Unfall 148:353\u2013360 (quiz 361\u2013362)","journal-title":"Z Orthop Unfall"},{"key":"686_CR14","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.clinbiomech.2006.08.009","volume":"22","author":"K Seide","year":"2007","unstructured":"Seide K et al (2007) Locked vs. unlocked plate osteosynthesis of the proximal humerus\u2014a biomechanical study. Clin Biomech (Bristol, Avon) 22:176\u2013182","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"686_CR15","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s13018-015-0242-4","volume":"10","author":"G Wang","year":"2015","unstructured":"Wang G et al (2015) Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures. J Orthop Surg Res 10:122","journal-title":"J Orthop Surg Res"},{"key":"686_CR16","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1007\/s00402-005-0803-9","volume":"125","author":"T Fjalestad","year":"2005","unstructured":"Fjalestad T, Str\u00f8ms\u00f8e K, Bl\u00fccher J, Tenn\u00f8e B (2005) Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital. Arch Orthop Trauma Surg 125:310\u2013316","journal-title":"Arch Orthop Trauma Surg"},{"key":"686_CR17","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/BOT.0b013e31821c2e15","volume":"26","author":"T Fjalestad","year":"2012","unstructured":"Fjalestad T, Hole M\u00d8, Hovden IAH, Bl\u00fccher J, Str\u00f8ms\u00f8e K (2012) Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Orthop Trauma 26:98\u2013106","journal-title":"J Orthop Trauma"},{"key":"686_CR18","doi-asserted-by":"crossref","first-page":"314","DOI":"10.55095\/achot2011\/048","volume":"78","author":"K Edelmann","year":"2011","unstructured":"Edelmann K, Obruba P, Kopp L, Cihl\u00e1\u0159 J, Celko AM (2011) Comparison of functional outcomes in angle-stable osteosynthesis of comminuted fractures of the proximal humerus with those in percutaneous Kirschner-wire fixation. A prospective study of mid-term results. Acta Chir Orthop Traumatol Cech 78:314\u2013320","journal-title":"Acta Chir Orthop Traumatol Cech"},{"key":"686_CR19","first-page":"591","volume":"110","author":"KJ Burkhart","year":"2013","unstructured":"Burkhart KJ et al (2013) The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int 110:591\u2013597","journal-title":"Dtsch Arztebl Int"},{"key":"686_CR20","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.jse.2004.01.034","volume":"13","author":"R Hertel","year":"2004","unstructured":"Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427\u2013433","journal-title":"J Shoulder Elbow Surg"},{"key":"686_CR21","first-page":"203","volume":"64","author":"RJ Neviaser","year":"2015","unstructured":"Neviaser RJ, Resch H, Neviaser AS, Crosby LA (2015) Proximal humeral fractures: pin, plate, or replace. Instr Course Lect 64:203\u2013214","journal-title":"Instr Course Lect"}],"container-title":["MUSCULOSKELETAL SURGERY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-020-00686-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12306-020-00686-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-020-00686-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T07:53:38Z","timestamp":1697270018000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12306-020-00686-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,30]]},"references-count":21,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["686"],"URL":"https:\/\/doi.org\/10.1007\/s12306-020-00686-4","relation":{},"ISSN":["2035-5106","2035-5114"],"issn-type":[{"value":"2035-5106","type":"print"},{"value":"2035-5114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,30]]},"assertion":[{"value":"1 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the institutional review board and performed in accordance with 1964 Helsinki Declaration.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}