Proximal humeral fractures are a common type of fracture, accounting for approximately 4%-5% of all fractures. 86% of proximal humeral fractures occur in people over 50 years old. With population aging intensifying, the incidence rate is on the rise. People in this age group often have degeneration of the long head of the biceps tendon (LHBT), combined with fracture trauma factors, and the combined injury of LHBT is relatively common. This combined injury may affect surgical outcome and reduce patients' quality of life. Multiple clinical studies have confirmed that the incidence of LHBT injury is relatively high among patients with proximal humeral fractures. Histological studies further confirmed significant degeneration, neovascularization, and an inflammatory response in the LHBT of these patients. These pathological changes were closely related to pain symptoms, providing a theoretical basis for intraoperative tendon management. At present, many surgeons attempt to perform LHBT treatment simultaneously during proximal humeral fracture surgeries. However, there is still controversy regarding the impact of concurrent LHBT treatment on the recovery of shoulder joint function in patients after proximal humeral fracture surgery.

To evaluate the clinical effect of locking plate fixation combined with LHBT fixation in the treatment of Neer 3/4 partial proximal humeral fractures in patients over 50 years old, with a focus on the improvement of shoulder joint function and biceps brachii tendinopathy-related symptoms.

A retrospective analysis was conducted on patients over 50 years old with Neer 3/4 proximal humeral fractures who underwent locking plate internal fixation surgery from January 2022 to March 2024. Cases of open fractures, combined nerve injury, multiple fractures, as well as complications such as osteonecrosis, fracture resorption, humeral head collapse, and internal fixation failure after surgery were excluded. Ultimately, 75 patients were included in the analysis, among which 31 cases were in the LHBT fixation group (21 cases in the Neer 3 part and 10 cases in the Neer 4 part), and 44 cases were in the control group (31 cases in the Neer 3 part and 13 cases in the Neer 4 part). After the operation, the Constant-Murley score (CMS) was used to evaluate the function of the shoulder joint, and the Speed test was used to detect biceps brachii tendon lesions.

CMS of the fixation group (84.9±4.9) points was significantly better than that of the control group (81.8±6.3) points (P=0.024), mainly reflected in the pain score of the fixation group (12.2±1.9) points vs (11.1±1.8) points, P=0.015. The performance was better in the sub-items, while the improvement in activities of daily living, activity level and muscle strength was not significant (P>0.05). In terms of biceps brachii tendon symptoms, the positive rate of the Speed test in the fixation group was significantly lower than that in the control group (5/31 vs. 20/44, P=0.008) .

For patients over 50 years old with Neer 3/4 proximal humeral fractures, concurrent LHBT fixation during surgery can relieve shoulder joint pain, alleviate symptoms related to LHBT lesions, and, to a certain extent, indirectly promote the recovery of shoulder joint function.