Humeral fractures in the elderly: treatment with a reamed intramedullary locking nail

In the elderly person, comorbidities combined with lower functional demands tend to indicate non-operative treatment; however, fast functional recovery is mandatory to prevent loss of independency and social ability. This retrospective follow-up study included 40 people with a mean age of 75 (range 60-87) years. They had all received treatment with a reamed intramedullary nail for humeral fracture; 21 were operated after a mean of 6 (range 0-16) days, and 19 after a mean of 28 (range 9-63) days after a primary decision for non-operative treatment. In all, 5 cases (12.5%) were lost to follow-up. The primary healing rate was 94% (33/35) after a mean of 17 (range 6-61) weeks; 14% (5/35) needed re-operation, in 2 cases because of healing problems. Functional results could be assessed in 18 cases: the median Neer score was 90 (range 45-97) points and the median Morrey score 98 (range 74-100) points. The relative functional scores were 94 (range 89-101) and 100 (range 97-100) points, respectively. All functional scores were independent of introduction site and time to treatment. On the basis of these results we conclude that treatment of humeral fractures in the elderly with an intramedullary nail leads to good healing and functional results, and an acceptable re-operation rate.