Proximal humerus fractures in the elderly: is there (still) a role for plate osteosynthesis?

Introduction: Proximal humeral fractures (PHFs) are among the most common fractures in the elderly population resulting from low energy trauma. The primary aim of this review is to assess the role of primary locking plate osteosynthesis in elderly patients with complex PHFs and highlight key surgical techniques to optimize outcomes. A literature overview and two illustrative cases are presented. Conclusion: Treating PHFs in elderly patients requires careful patient selection, adequate patient informed consent and shared decision making. Fit elderly (60–75 years) patients with complex 3- or 4-part PHF may benefit from plate osteosynthesis. For best outcomes, optimal anatomical and stable reconstruction of the medial hinge and tuberosities is mandatory and use of non-absorbable sutures for the rotator cuff is highly important. Augmentation with a fibula strut or cement could be considered to achieve optimal outcomes. In less fit elderly patients, with a complex 3- or 4- part fracture, reverse shoulder arthroplasty (RSA) may be preferable. It is important to provide both plate osteosynthesis and RSA options in practice.