OBJECTIVE This study reports the long-term surgical outcomes of elderly patients who underwent surgery using the modified Hackethal bundle nailing method on the basis of an approximately 10-year follow-up study. METHODS We treated 34 patients (7 males, 27 females) with 2- and 3-fragment fractures of the proximal humeral neck. Their ages at the time of operation ranged from 65 to 75 years (mean age, 69.5 years). They were classified as Neer group I (G-I, 8.8%), III (G-III, 79.4%) or IV (G-IV 11.8%). The duration of follow-up in patients averaged 130.6 months (range: 125.0 - 156.0 months). Patients were graded according to the Constant-Murley (CM) scoring system. Pre-operative and postoperative X-rays were also assessed. RESULTS All the fractures united within 6- 9 weeks, with an average of 7.4 weeks. The mean overall Constant score was 80.0 points (G-I: 83.3; G-III: 80.5; G-IV 75.6). Among the 34 patients, 30 (88.2%) obtained excellent results and 4 (11.8%) obtained good results. Mal-union in the coronal plane was observed in two patients (6.28%) who had 160 degrees angulation in three part fracture. Mal-union of the greater tuberosity occurred in one patient (3.14%) leading to limitation of abduction to 90 degrees. There were no cases of avascular necrosis, neurovascular complications or deep infections. CONCLUSIONS This study suggests that the modified H-technique is simple, less invasive, and a reliable and effective procedure for elderly patients.