Operative management of proximal humeral fractures using combined osteosynthesis . A narrative review

The osteosynthesis of complex proximal humeral fractures is still challenging. In addition to achieving anatomical reduction, the stability of the osteosynthesis is of paramount importance. Locking plate osteosynthesis has become established as the standard; however, particularly in complex fracture scenarios and in patients with reduced bone quality, significant complication rates are observed. In recent years, additive techniques such as augmentation, calcar screw, fibular graft, and double-plate osteosynthesis have been incorporated into the treatment portfolio. Biomechanical and preliminary clinical studies suggest an increase in stability and a reduction in complications. Nevertheless, it is still too early to single out a specific procedure and, thus, more high-quality and comparative clinical studies are required to provide evidence-based treatment recommendations.