Outcomes of nails versus plates for humeral shaft fractures: a Medicare cohort study

J Orthop Trauma. 2013 Feb;27(2):68-72. doi: 10.1097/BOT.0b013e31824a3e66.


Objectives: This study was performed to determine (1) the incidence of humeral shaft fractures within the Medicare noncancer population, (2) the trends in utilization of humeral shaft fixation techniques by plate-and-screw devices and intramedullary nails, (3) differences in procedure times, and (4) the outcomes of individuals as measured by rate of secondary operations and 1-year mortality.

Design/setting: Retrospective comparative cohort analysis. A cancer-free Medicare part B claims sample derived from a 5% sample from the years 1993 to 2007 was analyzed.

Patients/intervention: Our cohorts were generated by diagnostic and procedural codes for humeral shaft fractures.

Main outcome measurement: The incidence of humeral shaft fracture and trend in operative fixation were evaluated for all years of data. Surgical times were assessed by anesthesia Current Procedural Terminology codes. Outcomes and complications were assessed by Current Procedural Terminology codes. The proportion of individuals experiencing complications and 1-year mortality were compared by proportion hazards.

Results: We identified 1385 claims for humeral shaft fractures over 15 years, with an adjusted rate of between 12.0 and 23.4 fractures per 100,000 beneficiaries. We identified 511 individuals who received surgical treatment for humeral shaft fractures, 451 of whom had complete 1-year follow-up data. Nail fixation was more prevalent than plate fixation most years and had shorter anesthesia time by 27.1 minutes (P < 0.0001). There were no significant differences in the complication rates between the 2 groups as measured by incidence of secondary operations and 1-year mortality.

Conclusions: Intramedullary nails are used for the majority of operative humeral shaft fractures among Medicare beneficiaries. Nailing has a shorter mean operative time. The 2 surgical techniques had no significant differences in terms of risk of secondary procedures and 1-year mortality.

Level of evidence: : Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Nails
  • Bone Plates
  • Bone Screws
  • Cohort Studies
  • Fracture Fixation, Intramedullary / instrumentation*
  • Humans
  • Humeral Fractures / epidemiology
  • Humeral Fractures / surgery*
  • Male
  • Medicare
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome
  • United States / epidemiology