Clinical outcomes of locking plate fixation for proximal humerus fractures in patients aged 60 and older: A retrospective cohort study in Vietnam

Background: Proximal humerus fractures (PHF) are increasingly common among elderly patients and present significant treatment challenges, particularly in low-resource settings. While locking plate fixation is widely used and achieves reliable bone union, data on functional outcomes and real-world complications in Vietnamese populations remain limited. This study aims to evaluate the clinical outcomes of locking plate fixation in older patients and compare them to younger adults. Methods: We conducted a retrospective cross-sectional study involving 42 patients with closed PHF treated with locking plate fixation at Military Hospital 175 from January 2022 to December 2023. Data were collected during the 6-month postoperative follow-up. Variables included Constant-Murley scores, radiographic union status, complications, and scar evaluation. Patients were categorized into two groups: those under 60 and those 60 or older. Results: All patients achieved radiographic union by 6 months. The ≥60 groups exhibited a lower Constant score (60.58 ± 6.86) compared to the <60 groups (68.93 ± 8.82), and this difference was statistically significant (p < 0.01). Shoulder stiffness and scar stretching were more frequent in the elderly. No implant failures, deep infections, or reoperations were observed. Barriers to structured rehabilitation and limited access to physiotherapy were common among older adults. Conclusion: Locking plate fixation in elderly Vietnamese patients with PHF achieves high rates of bone union but only modest functional recovery. The limited improvement in shoulder function is likely related to age-associated factors and significant challenges in postoperative rehabilitation. These findings underscore the need for improved access to physiotherapy and comprehensive postoperative care in Vietnam. Larger, prospective studies using patient-reported outcome measures and longer follow-up are needed to guide future treatment strategies.