Minimally Invasive J-Nail Fixation for Neer Type 2, 3, and 4 Proximal Humerus Fractures in Elderly Patients: A Prospective Clinical and Radiological Outcome Study

Abstract

Abstract Introduction: Proximal humerus fractures are common in the elderly population and present significant management challenges. This study evaluates the efficacy of minimally invasive J-nail fixation for Neer type 2, 3, and 4 proximal humerus fractures in elderly patients. Material and Methods: Thirty patients aged over 60 years with proximal humerus fractures were treated with J-nail fixation at our institution between May 2023 and October 2024. Functional outcomes were assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) and Constant–Murley scores at regular intervals up to 6 months post-operatively. Radiological union and complications, including shoulder stiffness, were documented. Results: The mean age was 67.3 ± 6.71 years with 56.7% males. Fall was the predominant injury mechanism (46.7%). Neer type 2 fractures were most common (63.3%). The mean DASH score improved from 85.19 at 2 weeks to 19.4 at 6 months post-operatively (P < 0.001). The mean Constant–Murley score improved from 12.60 pre-operatively to 82.96 at 6 months (P < 0.001). Radiological union was achieved in all cases with a mean time of 12.8 ± 1.83 weeks. The complication rate was 30%, with stiffness (13.3%) being the most common. Conclusion: J-nail fixation is a viable minimally invasive technique for proximal humerus fractures in elderly patients, providing good functional outcomes with an acceptable complication profile. It offers advantages of minimal soft tissue disruption, preservation of vascularity, and early mobilization potential.