Inclusion Criteria:  Three and four-part proximal humeral fractures according to Neer classification system; Patients seventy years or older; Shoulder surgery within one week after trauma  Exclusion Criteria:  Exposed fractures; Pathological fractures; Proximal humerus fractures with metaphyseal or diaphyseal extension; Contraindications to surgery associated with organ dysfunctions or with coagulopathy; Allergy or hypersensitivity to the orthopedic implants; Patients who were unable to attend the different follow-ups; Patients with psychiatric disorders