Non-operative treatment is indicated for most proximal humeral fractures. In the treatment of patients with displaced fractures, the surgeon should choose a definitive and familiar treatment technique to achieve a stable reduction with a view to early postoperative joint rehabilitation activities. There are several treatment options available, and no one approach has a clear advantage for a particular type of fracture. Individualized treatment decisions based on patient and injury characteristics are recommended. Preliminary results of locking plates for the proximal humerus suggest that they are a good option for displaced comminuted proximal humeral fractures, with superior efficacy to other treatment options. Other internal fixation modalities and percutaneous pinning can also provide sufficient stability to promote shoulder motion and function. These traditional approaches have fewer complications and are less costly when performed with careful case selection and delicate surgical procedures. The locking plate technique can improve the stability of some complex fractures and facilitate early rehabilitation activities. Some fractures that are not considered for reconstruction can also be stabilized with locking plates. The rate of early arthrodesis of proximal humerus fractures will decrease as newer techniques make more and more fractures reconstructable. Further comparisons of the complications, efficacy, and cost-effectiveness of nonoperative and operative treatment will be necessary in the future.