Closed Reduction Internal Fixation with Titanium Elastic Nailing System for a Proximal Humerus Shaft Comminuted and Segmental Fracture

Segmental fractures of the proximal humeral shaft are rare and challenging to manage, particularly in elderly osteoporotic patients with multiple co-morbidities. Traditional open fixation methods carry risks of soft tissue complications, neurovascular injury, and delayed recovery. Minimally invasive techniques such as Closed Reduction and Internal Fixation (CRIF) with Titanium Elastic Nailing System (TENS) offer an alternative, though their use in segmental proximal humeral fractures remains underreported. We report the case of a 72-year-old female with diabetes mellitus, hypertension, and coronary artery disease, who presented with a segmental, comminuted fracture of the left proximal humeral shaft following trauma. Considering her co-morbidities, deranged blood parameters, and skin abrasions, CRIF with TENS under regional block anesthesia was performed. Two pre-bent elastic nails were inserted via medial and lateral entry points under C-arm guidance, achieving stable fixation with minimal blood loss and soft tissue disruption. The postoperative period was uneventful, with early initiation of physiotherapy and functional recovery. At follow-up, the patient demonstrated progressive callus formation, satisfactory cosmetic results, and functional range of motion without major complications. CRIF with TENS can serve as a safe and effective minimally invasive option for managing complex proximal humeral shaft segmental fractures in elderly patients with multiple comorbidities, offering advantages of reduced surgical morbidity, early rehabilitation, and improved cosmetic outcomes. Further studies are needed to establish its role in adult fracture management.