The treatment options of orthopedic surgeons for older adults with proximal humeral fractures (PHF) may vary according to chronological age. This study aimed to present the treatment modalities, complications, and mortality rates after PHF in octogenarians, nonagenarians, and centenarians from the Turkish national database.

This retrospective study was conducted using health records from the National Health Record System of Ministry of Health Turkey for individuals aged 80 and over who presented to public, private, and university hospitals from January 2016, to October 2024. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S42.2 (code for closed PHFs) was used to identify patients. A total of 9799 patients were included and categorized into three age groups: octogenarians (80–89 years), nonagenarians (90–99 years), and centenarians (≥100 years) and 4 groups according to treatment modalities (conservative, osteosynthesis, reverse shoulder arthroplasty (RSA), and hemiarthroplasty). Early systemic complications, revision surgery and mortality rates regarding 30-day and 90-day were recorded.

The mean age of the study population was 85.1 ± 4.2, ranging between 80–106 years. The female ratio was 76.1 %. Octogenarians comprised 84.3 % of the entire study population, whereas 15.5 % were nonagenarians and 0.3 % were centenarians. Conservative treatment was the most preferred across all age groups (62.3 %). Among patients initially managed conservatively, 7.0 % (n = 425) subsequently required surgical intervention, with no statistically significant difference in surgical conversion rates across the three age groups. Only 77 patients (0.8 %) underwent RSA. No differences were observed in the ratio of early systemic complications between octogenarians, nonagenarians, and centenarians. 30-day and 90-day mortality rates were 4.9 % and 10.2 %, respectively. RSA was associated with the highest risk of 90-day mortality (HR: 2.222, 95 % CI: 1.328–3.718; p = 0.002), with centenarians exhibiting an even greater risk (HR: 2.879, 95 % CI: 1.193–6.949; p = 0.019).

Conservative treatment remains the most preferred approach for PHFs in the patient population over the age of 80. Given the significantly higher mortality rates in centenarians and in patients undergoing RSA, individualized treatment decisions should prioritize functional outcomes, patient comorbidities, and life expectancy.