Comparative Functional and Radiological Outcomes of Locking Plate Fixation Versus Proximal Humeral Nailing for Displaced Two- and Three-Part Proximal Humerus Fractures: A 12-Month Comparative Study

Background: Proximal humerus fractures are common injuries, and both locking plate fixation and intramedullary nailing are established surgical treatment options.However, the relative advantages of these techniques remain debated, particularly regarding perioperative efficiency, functional recovery, range of motion, fracture union, and implant-related complications.Methods: This prospective, non-randomised comparative study included 60 patients with displaced two-part or three-part proximal humerus fractures according to the Neer classification; 30 underwent proximal humerus internal locking system (PHILOS) plating, and 30 underwent proximal humeral nailing (PHN).Treatment selection was based on fracture characteristics and the operating surgeon's clinical decision; random sequence generation and allocation concealment were not used.All patients completed 12 months of follow-up.Constant-Murley scores were assessed at 6 weeks, 12 weeks, 6 months, and 12 months.Repeated scores were analysed using a linear mixed-effects model with treatment group, categorical followup time, their interaction, and a patient-specific random intercept.Other continuous outcomes were compared using Welch independent-samples t-tests and categorical outcomes using chi-square or Fisher's exact tests, as appropriate.Results: Mean operative time was shorter with PHN than PHILOS (75.43 ± 8.92 vs 111.93 ± 10.64 minutes; p < 0.001), and mean estimated blood loss was lower (132.33 ± 33.37 vs 201.67 ± 39.90 mL; p < 0.001).Mean Constant-Murley scores increased in both groups over follow-up.The linear mixed-effects model showed no statistically significant group-by-time interaction (Wald χ²(3) = 6.72; p = 0.0814).At 12 months, the estimated PHN-minus-PHILOS difference was 2.60 points (95% CI: 0.97-4.23;p = 0.0018).Mean time to union was similar (15.23 ± 2.10 vs 15.53 ± 2.80 weeks; p = 0.640).Two complications occurred in each group (2/30, 6.7% per group; 4/60, 6.7% overall).Conclusions: PHILOS plating and PHN produced clinically similar shoulder function at 12 months in this cohort, despite a small statistically significant difference in Constant-Murley scores.PHN was associated with shorter operative time and lower estimated blood loss.The similar observed union and complication frequencies should not be interpreted as proof of equivalent safety, given the modest sample size and 12month follow-up.