Owing to demographic changes, the number of proximal humerus fractures is continuously rising and surgical treatment can be challenging [
1]. Nonoperative treatment with short-term immobilization and early functional exercises represents a well-established treatment option especially for minimally displaced fractures [
2,
3]. However, complex proximal humeral fractures are common, especially in the aging population [
2]. Primary arthroplasty must be considered in fractures where vascularity of the humeral head is impaired or an anatomical reduction and stable fixation cannot be achieved. However, in most remaining cases, especially in three- and four-part fractures when displacement of the tuberosities is present, locking plate osteosynthesis has been reported to be the gold standard [
4]. While intramedullary nailing might be an option for two-part fractures or more distal fractures with diaphyseal involvement, it often fails for complex fractures and has the potential disadvantage of affecting the rotator cuff [
4]. Angular stable plating has been introduced to specifically address displaced, unstable, and/or comminuted fractures of the proximal humerus. An anatomical reduction before plate fixation is crucial. Secondary displacement, implant malpositioning, or primary screw perforation are primary complications that might occur and should be avoided.
The following technique illustrates a standardized approach for an anatomical reduction, retention, and fixation using a locking plate osteosynthesis. This reproducible technique improves fixation with regard to primary stability, allowing for an early passive and active rehabilitation process.