Research progress on medial support augmentation techniques for proximal humeral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HE Peiyu ^1,2 , ZHENG Yubo ² , KONG Lingtong ² , LIU Haoyu ² ,  CHEN Hua ^1,2,3

1. Inner Mongolia Medical University, Hohhot Inner Mongolia, 010110, P. R. China;
2. Department of Orthopedics, the Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100048, P. R. China;
3. The First Department of Orthopedics, the First Medical Center, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding?author：

CHEN Hua, Email: chenhua0270@126.com

Keywords：

Proximal humeral fracture; medial support augmentation technique; osteoporosis; biomechanics

DOI：

10.7507/1002-1892.202601069

Video：

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Objective To conduct a comprehensive analysis of the historical evolution, current progress, and future prospects of medial support augmentation techniques for proximal humeral fractures (PHFs). Methods The recent domestic and international research literature on medial support augmentation techniques for PHF was extensively reviewed. Based on a comprehensive of the literature, the review focused on the biomechanical principles of the medial column of the proximal humerus, providing an in-depth critique of the development trajectory, biomechanical efficacy, and clinical outcomes of various medial support augmentation techniques. It also summarized the causes of fixation failure and strategies for managing complications, while offering potential future directions. Results Intraoperative application of medial support augmentation techniques in PHF can effectively reduce the incidence of postoperative mechanical complications, such as varus collapse and implant failure, by reconstructing the biomechanical stability of the medial proximal humerus, thereby improving clinical outcomes. These techniques are evolving towards diversification and precision, expanding from simple locking plate fixation to a comprehensive system that includes indirect bone grafting support, injectable bone cement augmentation, dual-plate fixation, and anatomical intramedullary support systems, all of which have demonstrated favorable clinical stability and low incidence of complication. However, some patients may still experience severe complications, such as varus displacement and screw cut-out, due to factors like comminution or deficiency of the medial cortex, osteoporosis-related insufficient screw purchase, or premature postoperative loading. For asymptomatic mild varus deformity, close observation may be sufficient; whereas for symptomatic implant failure, nonunion, or humeral head necrosis, revision surgery—such as bone grafting augmentation, implant exchange, or arthroplasty—should be considered. Conclusion Medial support augmentation technique represents a significant advancement and a key developmental direction in the management of PHF. The transition from empirical approaches to personalized strategies, facilitated by in-depth interdisciplinary collaboration to translate advanced scientific technologies into feasible and effective clinical measures, will be the primary driving force for addressing complex PHF in the future.

Citation： HE Peiyu, ZHENG Yubo, KONG Lingtong, LIU Haoyu, CHEN Hua. Research progress on medial support augmentation techniques for proximal humeral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(5): 695-701. doi: 10.7507/1002-1892.202601069 Copy

1.	Cederwall A, Karlsson MK, Rosengren BE. Time trends in proximal humeral fractures from 1944 to 2020—A cohort study in Malm?, Sweden. BMC Musculoskelet Disord, 2024, 25(1): 491. doi: 10.1186/s12891-024-07602-y.
2.	Sumrein BO, Huttunen TT, Launonen AP, et al. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int, 2017, 28(3): 901-907.
3.	Clement ND, Duckworth AD, McQueen MM, et al. The outcome of proximal humeral fractures in the elderly: predictors of mortality and function. Bone Joint J, 2014, 96-B(7): 970-977.
4.	Li Y, Zhao L, Zhu L, et al. Internal fixation versus nonoperative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials. PLoS One, 2013, 8(9): e75464. doi: 10.1371/journal.pone.0075464.
5.	Padegimas EM, Chang G, Namjouyan K, et al. Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation. J Shoulder Elbow Surg, 2020, 29(2): 291-295.
6.	Gardner MJ, Boraiah S, Helfet DL, et al. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma, 2008, 22(3): 195-200.
7.	Huang C, Liu B, Liu Z, et al. Modified PHILOS system utilizing a single bone cement calcar screw achieves optimal fixation stability and promotes bone healing: a biomechanical study and corresponding case series. BMC Musculoskelet Disord, 2025, 26(1): 641. doi: 10.1186/s12891-025-08854-y.
8.	Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg (Am), 2008, 90(2): 233-240.
9.	Katthagen JC, Schwarze M, Meyer-Kobbe J, et al. Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures. Clin Biomech (Bristol), 2014, 29(7): 735-741.
10.	Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg, 2004, 13(4): 427-433.
11.	Gardner MJ, Weil Y, Barker JU, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 2007, 21(3): 185-191.
12.	Ponce BA, Thompson KJ, Raghava P, et al. The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Joint Surg (Am), 2013, 95(16): e113(1-7). doi: 10.2106/JBJS.K.00202.
13.	Bai L, Fu Z, An S, et al. Effect of calcar screw use in surgical neck fractures of the proximal humerus with unstable medial support: a biomechanical study. J Orthop Trauma, 2014, 28(8): 452-457.
14.	Oppeb?en S, Wiker?y AKB, Fuglesang HFS, et al. Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years. J Orthop Surg Res, 2018, 13(1): 197. doi: 10.1186/s13018-018-0906-y.
15.	Esenyel CZ, Kurt E, Teksan E. Comparison of the varus displacement effect of calcar screw in proximal humerus fractures. Acta Orthop Belg, 2024, 90(3): 429-434.
16.	孫振國, 張占豐, 胡文林, 等. 異體腓骨髓內支撐結合鋼板內固定治療Neer Ⅳ型肱骨近端骨折的臨床療效. 中國骨傷, 2024, 37(3): 288-292.
17.	Lee SH, Han SS, Yoo BM, Kim JW. Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients: comparison with locking plate fixation alone. Bone Joint J, 2019, 101-B(3): 260-265.
18.	Jang Y, Kim D. Biomechanical study of proximal humeral fracture fixation: Locking plate with medial support screw vs. locking plate with intramedullary fibular graft. Clin Biomech (Bristol), 2021, 90: 105510. doi: 10.1016/j.clinbiomech.2021.105510.
19.	Wisanuyotin T, Paholpak P, Sirichativapee W, et al. Allograft versus autograft for reconstruction after resection of primary bone tumors: a comparative study of long-term clinical outcomes and risk factors for failure of reconstruction. Sci Rep, 2022, 12(1): 14346. doi: 10.1038/s41598-022-18772-x.
20.	Kim DY, Kim TY, Hwang JT. PHILOS plate fixation with polymethyl methacrylate cement augmentation of an osteoporotic proximal humerus fracture. Clin Shoulder Elb, 2020, 23(3): 156-158.
21.	吳峰, 劉園林, 蔡立雄, 等. 骨水泥增強鋼板螺釘固定老年肱骨近端骨折. 中國矯形外科雜志, 2021, 29(10): 901-905.
22.	Lecoultre Y, Beeres FJP, Link BC, et al. Cement augmentation for proximal humerus fractures: a meta-analysis of randomized trials and observational studies. Eur J Trauma Emerg Surg, 2024, 50(5): 2053-2060.
23.	佘榮峰, 張一, 王遠政, 等. 新型骨水泥強化螺釘結合鎖定鋼板內固定與人工肱骨頭置換治療肱骨近端骨質疏松性骨折的比較. 中國組織工程研究, 2020, 24(15): 2335-2341.
24.	Dankl L, Schmoelz W, Hoermann R, et al. Evaluation of mushroom-shaped allograft for unstable proximal humerus fractures. Arch Orthop Trauma Surg, 2022, 142(3): 409-416.
25.	Lodde MF, Raschke MJ, Stolberg-Stolberg J, et al. Union rates and functional outcome of double plating of the femur: systematic review of the literature. Arch Orthop Trauma Surg, 2022, 142(6): 1009-1030.
26.	姚燦, 楊光永, 婁菊紅, 等. 雙鋼板與單鋼板內固定治療肱骨近端骨折的臨床研究. 中國中醫骨傷科雜志, 2023, 31(6): 24-28, 35.
27.	He Y, He J, Wang F, et al. Application of additional medial plate in treatment of proximal humeral fractures with unstable medial column: a finite element study and clinical practice. Medicine (Baltimore), 2015, 94(41): e1775. doi: 10.1097/MD.0000000000001775.
28.	Chen H, Zhu ZG, Li JT, et al. Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A cohort study. Int J Surg, 2020, 73: 50-56.
29.	Bai X, Zhu Z, Chang Z, et al. Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults. BMC Musculoskelet Disord, 2022, 23(1): 1033. doi: 10.1186/s12891-022-05998-z.
30.	Zhu Z, Chang Z, Zhang W, et al. Biomechanical evaluation of novel intra- and extramedullary assembly fixation for proximal humerus fractures in the elderly. Front Bioeng Biotechnol, 2023, 11: 1182422. doi: 10.3389/fbioe.2023.1182422.
31.	Martinez-Catalan N, Boileau P. The role of intramedullary nailing for proximal humerus fractures: what works and what does not. Curr Rev Musculoskelet Med, 2023, 16(2): 85-94.
32.	章瑩, 肖進, 夏遠軍, 等. 肩關節骨折的數字化輔助治療. 臨床骨科雜志, 2013, 16(1): 45-48.
33.	吳昊, 羅良雨, 鄧新恒, 等. O臂導航輔助肱骨髓內釘與鎖定加壓鋼板內固定在肱骨復雜骨折中的應用效果研究. 臨床醫學工程, 2025, 32(11): 1239-1242.
34.	Kulkamthorn N, Rungrattanawilai N, Tarunotai T, et al. The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study. J Orthop Surg Res, 2022, 17(1): 6. doi: 10.1186/s13018-021-02892-7.
35.	Agudelo J, Schürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma, 2007, 21(10): 676-681.
36.	Solberg BD, Moon CN, Franco DP, et al. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma, 2009, 23(2): 113-119.
37.	Foruria AM, de Gracia MM, Larson DR, et al. The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg (Br), 2011, 93(3): 378-386.
38.	Hettrich CM, Boraiah S, Dyke JP, et al. Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg (Am), 2010, 92(4): 943-948.
39.	Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg, 2011, 20(5): 747-755.
40.	Nelson PA, Kwan CC, Tjong VK, et al. Primary versus salvage reverse total shoulder arthroplasty for displaced proximal humerus fractures in the elderly: a systematic review and meta-analysis. J Shoulder Elb Arthroplast, 2020, 4: 2471549220949731. doi: 10.1177/2471549220949731.
41.	Levy JC, Virani N, Pupello D, et al. Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg (Br), 2007, 89(2): 189-195.
42.	Frankle M, Levy JC, Pupello D, et al. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg (Am), 2006, 88 Suppl 1 Pt 2: 178-190.
43.	Lebus VGF, Mir HR, Bushnell BD. Reverse total shoulder arthroplasty for complex three- and four-part proximal humerus fractures in elderly patients: a review. Journal of Surgical Orthopaedic Advances, 2017, 26(2): 75-80.
44.	Abd-Elaziem W, Darwish MA, Hamada A, et al. Titanium-based alloys and composites for orthopedic implants applications: a comprehensive review. Materials & Design, 2024, 241: 112850. doi: 10.1016/j.matdes.2024.112850.
45.	Iwata H, Takada N, Kuroyanagi G, et al. Endosteal strut using a hydroxyapatite/poly-L-lactide mesh tube with a proximal humeral locking plate for the treatment of proximal humeral fractures. Eur J Orthop Surg Traumatol, 2024, 34(1): 217-223.
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1. Cederwall A, Karlsson MK, Rosengren BE. Time trends in proximal humeral fractures from 1944 to 2020—A cohort study in Malm?, Sweden. BMC Musculoskelet Disord, 2024, 25(1): 491. doi: 10.1186/s12891-024-07602-y.
2. Sumrein BO, Huttunen TT, Launonen AP, et al. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int, 2017, 28(3): 901-907.
3. Clement ND, Duckworth AD, McQueen MM, et al. The outcome of proximal humeral fractures in the elderly: predictors of mortality and function. Bone Joint J, 2014, 96-B(7): 970-977.
4. Li Y, Zhao L, Zhu L, et al. Internal fixation versus nonoperative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials. PLoS One, 2013, 8(9): e75464. doi: 10.1371/journal.pone.0075464.
5. Padegimas EM, Chang G, Namjouyan K, et al. Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation. J Shoulder Elbow Surg, 2020, 29(2): 291-295.
6. Gardner MJ, Boraiah S, Helfet DL, et al. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma, 2008, 22(3): 195-200.
7. Huang C, Liu B, Liu Z, et al. Modified PHILOS system utilizing a single bone cement calcar screw achieves optimal fixation stability and promotes bone healing: a biomechanical study and corresponding case series. BMC Musculoskelet Disord, 2025, 26(1): 641. doi: 10.1186/s12891-025-08854-y.
8. Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg (Am), 2008, 90(2): 233-240.
9. Katthagen JC, Schwarze M, Meyer-Kobbe J, et al. Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures. Clin Biomech (Bristol), 2014, 29(7): 735-741.
10. Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg, 2004, 13(4): 427-433.
11. Gardner MJ, Weil Y, Barker JU, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 2007, 21(3): 185-191.
12. Ponce BA, Thompson KJ, Raghava P, et al. The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Joint Surg (Am), 2013, 95(16): e113(1-7). doi: 10.2106/JBJS.K.00202.
13. Bai L, Fu Z, An S, et al. Effect of calcar screw use in surgical neck fractures of the proximal humerus with unstable medial support: a biomechanical study. J Orthop Trauma, 2014, 28(8): 452-457.
14. Oppeb?en S, Wiker?y AKB, Fuglesang HFS, et al. Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years. J Orthop Surg Res, 2018, 13(1): 197. doi: 10.1186/s13018-018-0906-y.
15. Esenyel CZ, Kurt E, Teksan E. Comparison of the varus displacement effect of calcar screw in proximal humerus fractures. Acta Orthop Belg, 2024, 90(3): 429-434.
16. 孫振國, 張占豐, 胡文林, 等. 異體腓骨髓內支撐結合鋼板內固定治療Neer Ⅳ型肱骨近端骨折的臨床療效. 中國骨傷, 2024, 37(3): 288-292.
17. Lee SH, Han SS, Yoo BM, Kim JW. Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients: comparison with locking plate fixation alone. Bone Joint J, 2019, 101-B(3): 260-265.
18. Jang Y, Kim D. Biomechanical study of proximal humeral fracture fixation: Locking plate with medial support screw vs. locking plate with intramedullary fibular graft. Clin Biomech (Bristol), 2021, 90: 105510. doi: 10.1016/j.clinbiomech.2021.105510.
19. Wisanuyotin T, Paholpak P, Sirichativapee W, et al. Allograft versus autograft for reconstruction after resection of primary bone tumors: a comparative study of long-term clinical outcomes and risk factors for failure of reconstruction. Sci Rep, 2022, 12(1): 14346. doi: 10.1038/s41598-022-18772-x.
20. Kim DY, Kim TY, Hwang JT. PHILOS plate fixation with polymethyl methacrylate cement augmentation of an osteoporotic proximal humerus fracture. Clin Shoulder Elb, 2020, 23(3): 156-158.
21. 吳峰, 劉園林, 蔡立雄, 等. 骨水泥增強鋼板螺釘固定老年肱骨近端骨折. 中國矯形外科雜志, 2021, 29(10): 901-905.
22. Lecoultre Y, Beeres FJP, Link BC, et al. Cement augmentation for proximal humerus fractures: a meta-analysis of randomized trials and observational studies. Eur J Trauma Emerg Surg, 2024, 50(5): 2053-2060.
23. 佘榮峰, 張一, 王遠政, 等. 新型骨水泥強化螺釘結合鎖定鋼板內固定與人工肱骨頭置換治療肱骨近端骨質疏松性骨折的比較. 中國組織工程研究, 2020, 24(15): 2335-2341.
24. Dankl L, Schmoelz W, Hoermann R, et al. Evaluation of mushroom-shaped allograft for unstable proximal humerus fractures. Arch Orthop Trauma Surg, 2022, 142(3): 409-416.
25. Lodde MF, Raschke MJ, Stolberg-Stolberg J, et al. Union rates and functional outcome of double plating of the femur: systematic review of the literature. Arch Orthop Trauma Surg, 2022, 142(6): 1009-1030.
26. 姚燦, 楊光永, 婁菊紅, 等. 雙鋼板與單鋼板內固定治療肱骨近端骨折的臨床研究. 中國中醫骨傷科雜志, 2023, 31(6): 24-28, 35.
27. He Y, He J, Wang F, et al. Application of additional medial plate in treatment of proximal humeral fractures with unstable medial column: a finite element study and clinical practice. Medicine (Baltimore), 2015, 94(41): e1775. doi: 10.1097/MD.0000000000001775.
28. Chen H, Zhu ZG, Li JT, et al. Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A cohort study. Int J Surg, 2020, 73: 50-56.
29. Bai X, Zhu Z, Chang Z, et al. Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults. BMC Musculoskelet Disord, 2022, 23(1): 1033. doi: 10.1186/s12891-022-05998-z.
30. Zhu Z, Chang Z, Zhang W, et al. Biomechanical evaluation of novel intra- and extramedullary assembly fixation for proximal humerus fractures in the elderly. Front Bioeng Biotechnol, 2023, 11: 1182422. doi: 10.3389/fbioe.2023.1182422.
31. Martinez-Catalan N, Boileau P. The role of intramedullary nailing for proximal humerus fractures: what works and what does not. Curr Rev Musculoskelet Med, 2023, 16(2): 85-94.
32. 章瑩, 肖進, 夏遠軍, 等. 肩關節骨折的數字化輔助治療. 臨床骨科雜志, 2013, 16(1): 45-48.
33. 吳昊, 羅良雨, 鄧新恒, 等. O臂導航輔助肱骨髓內釘與鎖定加壓鋼板內固定在肱骨復雜骨折中的應用效果研究. 臨床醫學工程, 2025, 32(11): 1239-1242.
34. Kulkamthorn N, Rungrattanawilai N, Tarunotai T, et al. The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study. J Orthop Surg Res, 2022, 17(1): 6. doi: 10.1186/s13018-021-02892-7.
35. Agudelo J, Schürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma, 2007, 21(10): 676-681.
36. Solberg BD, Moon CN, Franco DP, et al. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma, 2009, 23(2): 113-119.
37. Foruria AM, de Gracia MM, Larson DR, et al. The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg (Br), 2011, 93(3): 378-386.
38. Hettrich CM, Boraiah S, Dyke JP, et al. Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg (Am), 2010, 92(4): 943-948.
39. Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg, 2011, 20(5): 747-755.
40. Nelson PA, Kwan CC, Tjong VK, et al. Primary versus salvage reverse total shoulder arthroplasty for displaced proximal humerus fractures in the elderly: a systematic review and meta-analysis. J Shoulder Elb Arthroplast, 2020, 4: 2471549220949731. doi: 10.1177/2471549220949731.
41. Levy JC, Virani N, Pupello D, et al. Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg (Br), 2007, 89(2): 189-195.
42. Frankle M, Levy JC, Pupello D, et al. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg (Am), 2006, 88 Suppl 1 Pt 2: 178-190.
43. Lebus VGF, Mir HR, Bushnell BD. Reverse total shoulder arthroplasty for complex three- and four-part proximal humerus fractures in elderly patients: a review. Journal of Surgical Orthopaedic Advances, 2017, 26(2): 75-80.
44. Abd-Elaziem W, Darwish MA, Hamada A, et al. Titanium-based alloys and composites for orthopedic implants applications: a comprehensive review. Materials & Design, 2024, 241: 112850. doi: 10.1016/j.matdes.2024.112850.
45. Iwata H, Takada N, Kuroyanagi G, et al. Endosteal strut using a hydroxyapatite/poly-L-lactide mesh tube with a proximal humeral locking plate for the treatment of proximal humeral fractures. Eur J Orthop Surg Traumatol, 2024, 34(1): 217-223.
46. Pinto IN, Medeiros FdS, Nunes FCS, et al. Additive manufacturing of 3D networks based on poly (lactic acid) and amine functionalized graphene oxide as a platform for scaffolds. Journal of Applied Polymer Science, 2024, 141(21/22). doi: 10.1002/app.55396.
47. Koons GL, Diba M, Mikos AG. Materials design for bone-tissue engineering. Nature Reviews Materials, 2020, 5(Suppl 2): 584-603.
48. Ma XY, Han TY, Zhou DP, et al. Comparison of locking plate alone and locking plate combined with 3D printed polymethylmethacrylate augmentation in treating proximal humerus fractures in elderly. J Shoulder Elbow Surg, 2026, 35(3): 775-785.
49. Mizna S, Arora S, Saluja P, et al. An analytic research and review of the literature on practice of artificial intelligence in healthcare. Eur J Med Res, 2025, 30(1): 382. doi: 10.1186/s40001-025-02603-6.
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Chinese Journal of Reparative and Reconstructive Surgery

Research progress on medial support augmentation techniques for proximal humeral fractures

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