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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\u201375 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.<\/jats:p>","DOI":"10.1007\/s00068-025-02923-6","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T11:20:28Z","timestamp":1751628028000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Proximal humerus fractures in the elderly: is there (still) a role for plate osteosynthesis?"],"prefix":"10.1007","volume":"51","author":[{"given":"Charlotte M.","family":"Lameijer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leanne","family":"Blaas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert Jan","family":"Derksen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Wendt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"2923_CR1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S0895-4356(98)00167-X","volume":"52","author":"JA Barret","year":"1999","unstructured":"Barret JA, Karagas BJ, Beach MR. 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Multiple publications have resulted in which outcomes have been reported on conservative versus plate osteosynthesis versus reversed shoulder arthroplasty. For this manuscript; no funding was obtained or used. We believe we have described a reliable and independent overview of literature regarding plate osteosynthesis for the fit elderly.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"244"}}