Ender nailing for unstable surgical neck fractures of the humerus in elderly patients

The purpose of this study was to assess the effects of stabilization of displaced and unstable surgical neck fractures of the humerus by Ender nailing followed by protected passive range of motion exercise of the shoulder. Thirty-four patients (29 women and 5 men) with such fractures were treated. The average age of patients was 69.5 years (range, 48-86 years), and the average followup period was 9.9 months (range, 6-22 months). Protected passive range of motion of the shoulder was started in 2 weeks after surgery for 25 patients and in 3 to 4 weeks for 9 patients. All patients experienced pain relief immediately after surgery. Bone union occurred at 5.9 weeks (range, 4-10 weeks) in all but 1 patient. The average range of motion of the shoulder at followup was 129.7 degrees elevation and 43.2 degrees external rotation. The average limitation of elbow extension was 4.3 degrees. The most important points of this procedure are to obtain immediate relief of pain, to stabilize the unstable fragment, and to begin protected passive range of motion of the shoulder before extensive adhesions develop.