Plate osteosynthesis of proximal humerus fractures: treatment options and technical advancements

Proximal humerus fractures are the third most common fracture in the elderly, producing an impressive social and economic burden. Their treatment is still controversial in the literature, with unconclusive evidence regarding the best therapeutic choice. Osteosynthesis with locking plates is considered the main surgical treatment, providing good clinical and radiographic outcomes over solid biomechanical bases, even if high complication rates have been reported. The main complications are intra-articular screw penetration, varus collapse, and avascular necrosis of the humeral head. In order to reduce the complication rate, it is necessary to correctly select patients who are suitable for surgical treatment; provide an adequate reduction of the fracture; effectively address medial hinge disruption; avoid complications related low bone quality. Many technical options to achieve better results have been developed, ranging from design modification to allograft augmentation. The aim of this review is to provide up-to-date information to aid the surgeon in choosing the correct treatment for the individual patient.