Abstract: Objective To compare the efficacy of intramedullary reduction technique and leverage reduction technique combined with locking plate in the treatment of elderly patients with complex proximal humeral fractures. Methods The patients with proximal humeral fracture treated in our hospital from September 2020 to September 2022 were selected and divided into group A (receiving leverage reduction) and group B (receiving intramedullary reduction) by random number table method, with 24 cases in each group. The operation time, fluoroscopy time, the imaging indicators, Constant-Murley score and visual analogue scale (VAS) score 3 days and 12 months after surgery, and the incidence of reduction loss 12 months after surgery were recorded and compared between the two groups. Results The operative time and fluoroscopy time in group B were shorter than those in group A (P<0.05 or P<0.01).There were no statistically significant differences in humeral head-shaft angle and humeral head height between the two groups 3 days and 12 months after surgery (P>0.05), but the loss of humeral head-shaft angle and humeral head height in group A were greater than those in group B (P<0.05). Compared with 3 days after surgery, the scores of VAS and Constant-Murley in both groups were significantly improved 12 months after surgery, and especially in group B (all P<0.05).The reduction loss rate in group B was significantly lower than that in group A (4.2% vs 33.3%, P<0.05). Conclusions Intramedullary reduction technique for the treatment of proximal humeral fractures in aged osteoporotic patients can shorten the operative time, reduce the exposure time of patients and medical staff to radiation, improve the reduction quality of humeral calcar, reduce the risk of postoperative reduction loss, and improve the postoperative shoulder joint function.

Key words: aged, proximal humeral fractures, open reduction and internal fixation, reduction technique