Intramedullary nailing versus plate fixation for humeral shaft fractures in geriatric patients: a retrospective cohort study assessing functional outcomes and complication rates.

BACKGROUND: Humeral shaft fractures, accounting for 1-3% of adult fractures, increasingly require surgical intervention due to high nonunion rates. This study compares outcomes of intramedullary nailing and plate fixation in older adults. METHODS: A retrospective analysis was conducted on 55 patients with humeral shaft fractures treated at the Mohamed Taieb Kassab Orthopedic Institute between 2014 and 2022. The cohort included 32 patients managed with intramedullary nailing (IMN) and 23 with dynamic compression plating (DCP). Demographics, fracture characteristics (AO classification), operative duration, union duration, functional outcomes (modified Stewart and Hundley criteria, Constant-Murley score), and complications were evaluated. Statistical analysis used SPSS v19.0. RESULTS: Mean age was 64.7 years, with male predominance (40 male, 15 female and a gender ratio of 2.6). IMN was preferred for middle-third (58%) and AO type A fractures (79.4%), while DCP dominated complex fractures (76.2% type B/C with p < 0.05).IMN demonstrated shorter operative duration (60.2 ± 4.4 vs. 105.9 ± 7.7 min and p < 0.001). Fracture union averaged 19.9 ± 7.9 weeks, with no intergroup difference (p = 0.360). Functional outcomes (76.4% good or excellent) were comparable between techniques (p > 0.05), but DCP yielded superior Constant-Murley scores (91.1 ± 10.5 vs. 80.6 ± 15.4 and p = 0.007). Complications included shoulder stiffness (25% IMN, 0% DCP and p = 0.015), complex regional pain syndrome (CRPS) (15.6% IMN, 0% DCP), sepsis (4.3% DCP, 0% IMN), and radial nerve palsy (4.3% DCP, 0% IMN). CONCLUSION: IMN offers faster surgery and lower infection risk but higher shoulder morbidity. Plate fixation excels in complex fractures with better functional scores but longer operative duration and infection risk. Considering these factors, DCP may be the preferred approach in older adults compared to IMN, particularly when functional optimization is a priority. The choice of surgical technique should be guided by fracture characteristics, patient's specific factors, and surgeon expertise.