Comparative Analysis of Intramedullary Nailing and Plate Fixation in Geriatric Humeral Shaft Fractures

Geriatric patients with humeral shaft fractures treated with intramedullary nailing have roughly 45 minutes shorter operative time on average than those treated with plate fixation—reducing anesthesia and theatre exposure and lowering perioperative risk in older adults. This time difference is clinically actionable when balancing procedural risk against expected recovery.

The finding comes from a retrospective cohort of 55 geriatric patients (32 intramedullary nails, 23 plates) followed a mean of ~12–13 months. Primary endpoints included operative duration, Constant–Murley functional score, and complications. Operative time strongly favored the nail group (60.2 ± 4.4 min vs. 105.9 ± 7.7 min; p < 0.001), confirming a substantial efficiency advantage for intramedullary nailing—an important consideration for higher-risk older adults.

Functional outcomes favored plate fixation, which produced higher Constant–Murley scores (mean 91.1 ± 10.5 vs. 80.6 ± 15.4 for nails; p = 0.007). The benefit was driven mainly by comminuted and segmental (AO type B/C) fracture patterns; the roughly 10‑point difference corresponds to improved shoulder range of motion and strength in complex fractures. For patients where anatomical reduction and maximal shoulder function are priorities, plates may therefore be preferable.

Complication profiles diverged by implant. Intramedullary nailing had lower infection/sepsis incidence (0/32 [0%] vs. 1/23 [4.3%] with plating) but higher shoulder morbidity (shoulder stiffness 8/32 [25%] vs. 0/23 [0%]; CRPS 5/32 [15.6%] vs. 0/23 [0%]). Plating carried isolated risks of sepsis and a small risk of iatrogenic radial nerve palsy (1/23 [4.3%]). Nonunion was uncommon and similar overall, with one revision from nail to plate reported. Patient factors—bone quality, comorbidity burden, fracture morphology, and preinjury function—should therefore guide implant selection: favor nails when operative efficiency and infection avoidance are priorities, and plates when fracture complexity and functional recovery demand anatomical fixation. Given the small group sizes (n=32 and n=23), these percentage differences reflect small counts and warrant cautious interpretation.