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. ConclusionMedial 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.