Proximal humerus fractures are among the most frequent fractures in the elderly population. While nondisplaced fractures can be managed conservatively, there is controversy regarding the appropriate management of displaced fractures. While several studies have demonstrated good results with non-operative management of displaced fractures in elderly patients, there is growing interest in surgical treatment with either fixation or arthroplasty to improve outcomes for younger or active elderly patients. Open reduction internal fixation with locking plate fixation remains the cornerstone of fracture fixation, but the indications for reverse total shoulder arthroplasty are expanding as longer-term outcomes data become available. This chapter reviews the initial evaluation, surgical indications, technical tips for fracture fixation and arthroplasty, postoperative protocols, and outcomes for these fractures.