Progress in the treatment of complex osteoporotic proximal humeral fractures in elderly patients

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.