When proximal humeral fractures (PHFs) are treated with locking plates, bone grafts are recommended in elderly and osteoporotic patients at risk for fixation failure to improve stability and reduce complication [1]. Although Patients aged less than 65 years account for about 30% of all PHFs [2,3], it is unknown whether a bone graft is needed in patients less than 65 years, especially those patients with bone defects, a broken medial cortex, or with complex fractures. Nonuse of bone grafts may reduce the operation time and medical costs. More importantly, it can avoid complications associated with bone grafting, such as difficulty in absorption (with allografts) and donor site morbidity (with autogenous grafts) [4,5]. However, lack of stability could result in re-displacement, thereby causing loss of reduction and even nonunion. Finally, an important question is whether a bone graft is necessary for displaced PHFs among patients less than 65 years old.

The aim of this study was to compare the differences in radiographic and clinical outcomes between PHFs treated with locking plates alone and those treated with bone grafts augmentation combined with locking plates, and to identify whether patients less than 65 years old benefit from bone grafts.