Abstract: [Objective] To observe the efficacy of medial column support reconstruction combined with Multiloc intramedullary nail internal fixation in the treatment of proximal humeral fractures (PHF) in the elderly. [Method] A retrospective analysis was conducted on the clinical data of 84 elderly patients with PHF admitted to our Hospital from January 2020 to December 2022. Among them, 40 patients underwent treatment with Multiloc intramedullary nail fixation (intramedullary nail group), and 44 patients underwent treatment with medial column support reconstruction combined with Multiloc intramedullary nail (combined group). Compare the perioperative conditions, follow-up, and imaging indicators between the two groups. [Result] The surgical time in the combined group was significantly longer than that in the intramedullary nail group (P<0.05), and the postoperative time of getting out of bed and hospitalization were significantly shorter than those in the intramedullary nail group (P<0.05). There was no significant difference in the total incidence of complications between the two groups (4.55% vs 15.00%) (P>0.05). The clinical healing time, imaging complete healing time, and complete weight bearing time of patients in the combined group were significantly shorter than those in the intramedullary nail group (P<0.05); The visual analogue score (VAS) of pain in the combined group was significantly lower than that in the intramedullary nail group 3 months and 12 months after surgery (P<0.05), and the Broberg Morrey score, Shoulder joint Constant Murley score and Neer score were significantly higher than those in the intramedullary nail group (P<0.05). Twelve months after operation, the range of motion of Shoulder joint flexion and lifting, external rotation and external lifting in the combined group were significantly higher than those in the intramedullary nail group (P<0.05), and the humeral neck shaft angle and femoral head varus were significantly lower than those in the intramedullary nail group (P<0.05). [Conclusion] The combination of medial column support reconstruction and multiloc intramedullary nail internal fixation is safe and effective in the treatment of elderly PHF, which can promote the functional recovery of elbow joint and Shoulder joint, and improve the range of motion of Shoulder joint joint