In recent years, the incidence of proximal humeral fractures has been increasing year by year, reaching 4% to 5% of systemic fractures. With the progress of the aging population, the incidence of significantly displaced proximal humeral fractures has increased by 50%. Early open reduction and internal fixation (ORIF) has become a consensus in treating complex proximal humeral fractures. However, in the complex Neer part-3 or 4 proximal humerus fractures, the destroyed medial humeral support structure will significantly negatively impact postoperative functional recovery. The current research believes that providing reliable medial support while reducing the fracture is significant for decreasing postoperative complications and achieving good functional recovery. However, there are different opinions on the selection of support methods.

To explore the clinical effect of medial column reconstruction with autogenous iliac bone graft and Calcar screw in the treatment of proximal humeral fractures.

From January 2016 to December 2018, 36 patients with unilateral complex proximal humeral fractures were treated in our hospital with autogenous iliac bone graft combined with Calcar screw. The follow-up period ranged from 12 to 24 months, with an average of 17.04 months. Neer shoulder function score and Constant-Murley score were recorded at 3^rd, 6^th, and 12^th months after the operation, and the degree of postoperative pain was evaluated with visual analogue scale (VAS) . The time of fracture healing, complications, and the range of motions of the shoulder joint were analyzed.

All 36 patients achieved anatomical reduction, and the average healing time of the fractures was 3.71 months. No avascular necrosis (AVN) of the humeral head or varus collapse occurred. In the 12-month follow-up, the Neer function score, Constant-Murley score, and VAS score were (84.64 ±3.40) , (74.26 ±4.70) , and (1.24±0.72) , respectively. The range of motions of the affected shoulder joint were (132.58 ±8.01) ° of flexion, (43.75 ±3.41) ° of extension, (58.25 ±4.89) ° of internal rotation, (58.89 ±4.8) ° of external rotation, and (136.46 ±11.04) ° of abduction.

For complex proximal humeral fractures with medial comminution, autogenous iliac bone graft combined with Calcar screw can provide reliable medial support, reduce the risk of varus collapse, AVN, and other complications, and the postoperative functional recovery is satisfactory.