The treatment of proximal humeral fractures remains a challenge for orthopaedic surgeons, and there is no clear consensus in the orthopaedic community on how to treat proximal humeral fractures. When the bone quality of the proximal humerus is poor, it is often difficult to obtain secure fixation of the fracture. Although anatomic plates and angular stability screws for the proximal humerus have emerged with the advent of technology, the efficacy of internal fixation for proximal humeral fractures remains suboptimal. The thoracic deltoid approach is the traditional surgical approach for proximal humeral fractures, which is characterized by good exposure of the glenohumeral joint but poor exposure of the surgical area for proximal humeral fractures, a disadvantage that is more evident when only locking plates are used to treat proximal humeral fractures. The surgical approach is located anterior to the shoulder joint, which makes it difficult to expose the lateral humerus where the locking plate is placed, and it is also difficult to fix the trajectory of the locking plate when the screws are placed, i.e., from the outside in, and to complete the drilling and nail placement within the anterior incision. Therefore, sutures on the rotator cuff are usually used as traction to maintain internal rotation of the humeral head during the procedure, thus achieving full exposure of the lateral humeral head. The humeral head repositioning and plate placement usually requires constant internal or external rotation of the forearm, which may result in loss of position of the repositioned humeral head or well-positioned plate. The extensive soft tissue stripping associated with this approach may also adversely affect the healing of proximal humeral head fractures. There is a potential risk of injury to the anterior rotator humeral artery, which may increase the likelihood of ischemic necrosis of the humeral head. For these reasons, the thoracic deltoid approach is not the best approach for the treatment of proximal humeral fractures. The anterolateral acromial ALA approach addresses some of the difficulties in the surgical treatment of proximal humeral fractures, reduces soft tissue injury, and allows for easy placement of the construct in an optimal position; combined with the indirect reduction technique, it results in less local soft tissue disruption of the fracture and significantly improves the functional prognosis. Professor Mark Jo of Huntington Memorial Hospital, Huntington, California, USA, provides a detailed description of the surgical approach and technique of the anterolateral approach to the acromion for the treatment of proximal humeral fractures, with results published in Techniques in Orthopaedics, Vol. 28, No. 4, 2013. When using the anterolateral approach to the acromion, the patient is placed in the beach chair or prone position while ensuring intraoperative fluoroscopy of the proximal humerus in the anterior-posterior and axillary positions. In the beach chair position, some of the removable accessories of the surgical bed should be removed to ensure intraoperative fluoroscopy. In the flat position, the patient should be moved outward to a fluoroscopic table to ensure fluoroscopy. Fluoroscopy is performed prior to disinfection of the towel to confirm that fluoroscopy can be completed intraoperatively. Mark the external edges of the acromion and clavicle, the rostral process, and the anatomic landmarks of the acromioclavicular joint. Anatomic studies have demonstrated that the axillary nerve is anatomically located approximately 6.5 cm below the inferior border of the acromion in the neutral position of the upper extremity. Intraoperatively, care should be taken to maintain the position of the upper extremity, as abduction of the shoulder joint changes the position of the axillary nerve by up to 1 cm when the shoulder joint is abducted at 60°. To guide later surgical incision, the horizontal position of the axillary nerve should also be marked on the skin, but the operator should be aware that this only provides the approximate position of the axillary nerve, and that due to fractures, normal anatomical variations, and the position of the upper extremity The location of the axillary nerve may still be subject to change.