The shoulder joint is the joint between the upper limb and the thorax, and is the perfect combination of a flexible and stable joint, strength and precise movement so that it can meet the various functional requirements of humans. Fractures of the proximal humerus, an important component of the shoulder joint, often cause damage to the function of the shoulder joint, which in turn can seriously affect the quality of life of patients, especially in elderly patients. It includes fractures of the humeral head, greater tuberosity, lesser tuberosity, proximal humeral stem and other structures. The incidence of these fractures accounts for 4% to 9% of all fractures in the body, and most patients are elderly with osteoporosis, and the incidence is bound to continue to rise as the population ages and the comorbidities of patients become more complex. Both factors place higher demands on orthopaedic surgeons. Non-operative therapy is the basis of treatment for proximal humerus fractures. 80% or more of proximal humerus fractures without displacement or with slight displacement, unless the anatomic neck of the humerus is involved, can generally be treated non-operatively. In contrast, nonoperative therapy is the natural choice for patients for whom surgery is contraindicated or refused. Several publications have reported that non-operative treatment, even for two-, three-, or even four-part Neer fractures, can achieve functional results comparable to those of surgical treatment, with a low rate of fracture nonunion, although the improvement in fracture mass position is not comparable to that of surgical treatment. Today, although the use of surgery for proximal humeral fractures is increasing, there is a lack of high-quality, prospective randomized controlled trials to determine whether surgical treatment is truly superior to nonoperative treatment for displaced, unstable fractures. In this column, the study by Harm W. Boons compared the efficacy of conservative treatment with humeral head replacement in the treatment of four-part fractures in patients over 65 years of age, with the latter not showing a significant advantage. This is the reason why earlier this year Finland in Northern Europe planned a nationwide, three-year multicenter RCT study to compare the efficacy of non-surgical treatment with two surgical methods (locking splints and prosthetic replacement) in order to optimize treatment options and reduce health care expenditures. Let’s wait and see. Surgical internal fixation for proximal humeral fractures began in the 1930s, while prosthetic replacement appeared later in the 1950s. in the 1970s, the AO Society promoted the concept and technique of the splint screw and redesigned the humeral head prosthesis, making surgical treatment of proximal humeral fractures gradually popular. In our country, it is only in the last 20 years that the surgical approach has become widely used to treat these fractures. In terms of indications for surgery, except for open fractures, dislocations with neurovascular injuries, floating shoulder injuries, and dislocations with difficult closed repositioning, which are absolute indications, all other cases are relative indications and are considered in a comprehensive manner depending on the type of fracture, fracture site, patient compliance, operator experience and skill, and rehabilitation conditions. In September, Kanu Okike and other scholars published in Injury about the factors influencing the choice of treatment modality and found that patients with advanced age, severe fractures, combined with other orthopedic injuries, and combined with dislocation of the shoulder glenoid joint had a greater chance of receiving surgical treatment, and that shoulder or upper limb surgeons were more likely to choose surgical treatment than trauma surgeons. Because proximal humeral fractures, like hip fractures, are increasingly becoming an important socio-medical problem, many scholars have conducted research in recent years on endograft development, improved surgical techniques and surgical outcomes, and minimally invasive procedures, and the literature presented in this column is only a recent drip. Synthesizing most of the literature, the starting point is no more than two aspects: one is the selection of an effective internal fixation and the other is the consideration of the blood flow to the humeral head. Improvements in internal fixation, the development of shoulder prostheses, and the application of various adjunctive techniques and skills are all based on both aspects. The different surgical techniques have their own characteristics, are suitable for different fracture types and different patient and bone conditions, and have their own disadvantages and complications. Orthopaedic surgeons are familiar with this part and will not repeat it here. Regardless of non-operative or operative treatment, internal fixation or prosthetic replacement, standardized functional rehabilitation is an important factor in achieving good function in proximal humerus fractures, which is often overlooked or underestimated by many orthopaedic surgeons, especially in primary care hospitals and hospitals without rehabilitation units. Elderly patients are often unable to perform effective exercises on their own due to fear of pain; and incorrect exercises will also affect function and prevent the surgery from achieving the desired effect: being too conservative will lead to joint stiffness, and being too aggressive will impair the healing of the joint capsule and rotator cuff, thus affecting shoulder joint stability and function. Therefore, postoperative psychological counseling should be provided by a rehabilitation physician in a timely manner. Improve and eliminate patients’ psychological barriers and guide correct functional training. In primary hospitals lacking specialized departments, orthopedic surgeons with the necessary knowledge of rehabilitation and regular planned and purposeful guidance to patients will certainly greatly improve the prognosis, bring into play the advantages of surgery, and ultimately benefit patients.