Home›Orthopedics & Sports Medicine› Locking plate fixation and arthroplasty are key treatments for osteoporotic proximal humeral fractures
Locking plate fixation and arthroplasty are key treatments for osteoporotic proximal humeral fracturesMainstream Treatments for Complex Osteoporotic Shoulder Fractures
Frontiers in MedicinePublished June 23, 2026DOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
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Key Takeaway
Consider locking plate fixation or arthroplasty for elderly patients with complex osteoporotic proximal humeral fractures, guided by fracture classification.
This systematic review examines mainstream treatments for elderly patients with complex osteoporotic proximal humeral fractures. The review covers locking plate fixation, intramedullary nailing, hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. It discusses clinical application, biomechanical characteristics, functional outcomes, and complications of these strategies.
Key findings include that treatment options vary based on fracture classification, and the review highlights the importance of medial calcar reconstruction, biological augmentation, intelligent surgical technology, and degradable biomaterials. However, no pooled effect sizes or comparative data are reported.
The authors clarify limitations of existing studies, which include heterogeneity in patient populations and outcome measures. The review does not provide primary trial data but synthesizes available evidence.
For practice, the review offers evidence-based references to guide individualized diagnosis and treatment of senile osteoporotic proximal humeral fractures. Clinicians should consider patient-specific factors when selecting among the discussed surgical options.
How this fits prior evidence
This systematic review extends prior coverage of osteoporosis management by focusing on surgical treatment of proximal humeral fractures. Previous items discussed circadian disruption, botanical drugs, CD8+ T cell pathways, and novel therapies for osteoporosis, but none addressed fracture-specific surgical strategies. This review fills a gap by summarizing mainstream surgical options for osteoporotic proximal humeral fractures, complementing earlier discussions on bone metabolism and therapeutic targets.
This review looks at how to treat complex proximal humeral fractures in elderly patients with osteoporosis. These types of fractures are common and can be difficult to manage because of weakened bone structure. The review examines several mainstream surgical options to help doctors provide better care.
The main treatments reviewed include locking plate fixation, intramedullary nailing, hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. Each method has different biomechanical characteristics and can lead to different functional outcomes for the patient.
Because this is a review of existing literature rather than a new clinical trial, it does not provide specific data on individual success rates or side effects. It serves as a guide for doctors to choose the best treatment based on a patient's specific needs. Patients should talk to their surgeon to discuss which option is safest and most effective for their specific injury.
What this means for you:
Several surgical options exist for complex shoulder fractures in elderly patients with osteoporosis.
Common questions
What are the main surgical options for a fractured shoulder in older adults?
There are several mainstream treatment strategies available. These include locking plate fixation, intramedullary nailing, hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. Each method is evaluated based on its biomechanical characteristics and how well it helps the patient regain function after a complex fracture.
How do doctors choose which surgery is best for an osteoporotic fracture?
Doctors use evidence-based references to provide an individualized diagnosis and treatment plan. Because every patient's fracture is different, the choice between options like locking plates or various types of arthroplasty depends on the specific complexity of the fracture and the patient's overall health.
Is there a single best way to treat these fractures?
The review identifies multiple mainstream strategies rather than one single best method. Options range from internal fixation with plates or nails to various types of joint replacements. The best choice depends on the specific type of fracture and the patient's needs, which should be discussed with a medical professional.
Proximal humeral fracture is one of the most prevalent osteoporotic fractures in the elderly, ranking third after hip and distal radius fractures and accounting for approximately 10% of all geriatric fractures. With population aging, its global incidence continues to rise annually. Most mild and stable fractures can be managed conservatively, while nearly 15%–20% of displaced complex fractures require surgical intervention. Current mainstream strategies include locking plate fixation, intramedullary nailing, hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. Owing to poor bone quality and multiple comorbidities in elderly patients, individualized treatment based on fracture classification, medial calcar integrity and functional demands is essential. This review systematically summarizes the clinical application, biomechanical characteristics, functional outcomes and complications of mainstream treatments for elderly proximal humeral fractures. Latest advances in fracture classification, medial calcar reconstruction, biological augmentation, intelligent surgical technology and degradable biomaterials are elaborated. Meanwhile, the limitations of existing studies and future research directions are clarified, aiming to provide evidence-based references for clinical individualized diagnosis and treatment of senile osteoporotic proximal humeral fractures.
