{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:47:48Z","timestamp":1760122068311,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:00:00Z","timestamp":1672876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complications. Materials and Methods: The present study included patients with FHS, treated via either intramedullary nailing or plating within a period of 10 years, with a minimum follow-up of 12 months. Functional outcome was assessed using the age- and sex-adapted Constant\u2013Murley Score (CMS-K). Rates of complications and revision surgeries were registered. Results: Twenty-five patients (18 females, 7 males, age 60.1 \u00b1 14.2 years, range 23\u201376 years) were included in the study. Nailing was performed in 16 patients (12 females, 4 males, age 62.6 \u00b1 12.4 years), whereas plating was executed in nine patients (6 females, 3 males, age 55.8 \u00b1 17.0 years). Follow-up among all patients was 45.1 \u00b1 26.3 months (range 12\u201397 months). CMS-K was 70.3 \u00b1 32.3 in the nailing group, with reoperation in four cases, and 76.0 \u00b1 31.0 in the plating group, with one reoperation (p = 0.42). Patients with no metaphyseal fragment displacement (n = 19; CMS-K 76.7 \u00b1 17.3) demonstrated significantly better functional outcomes versus those with secondary displacement of the metaphyseal fragments (n = 6; CMS-K 60.0 \u00b1 17.1), p = 0.046. Conclusions: Comparable acceptable clinical outcome is obtained when comparing nailing with additional open cerclage or lag-screw fixation techniques versus plating with open reduction. However, a higher revision rate was observed after nailing. The correct metaphyseal fragment fixation seems to be crucial to avoid loss of reduction and hence the need for revision surgery, as well as a worse outcome.<\/jats:p>","DOI":"10.3390\/medicina59010113","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T01:48:19Z","timestamp":1672969699000},"page":"113","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1087-7503","authenticated-orcid":false,"given":"Firas","family":"Souleiman","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany"},{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2884-8030","authenticated-orcid":false,"given":"Jan","family":"Theopold","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5274-1896","authenticated-orcid":false,"given":"Ralf","family":"Henkelmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5051-0998","authenticated-orcid":false,"given":"Georg","family":"Osterhoff","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4357-236X","authenticated-orcid":false,"given":"Torsten","family":"Pastor","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"},{"name":"Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-115X","authenticated-orcid":false,"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Fakler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6510-2943","authenticated-orcid":false,"given":"Pierre","family":"Hepp","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of Adult Fractures: A Review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1007\/s00402-009-0889-6","article-title":"Bone Quality Measured by the Radiogrammetric Parameter \u201cCortical Index\u201d and Reoperations after Locking Plate Osteosynthesis in Patients Sustaining Proximal Humerus Fractures","volume":"129","author":"Hepp","year":"2009","journal-title":"Arch. 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