Displaced fractures of the proximal humerus in elderly patients continue to represent a challenge in orthopaedics. In addition to the complex geometry and multiple muscle forces acting across the glenohumeral joint, problems with bone healing due to comminution and/or poor bone quality, particularly with regard to fixation of the greater tuberosity, often add to the difficulties associated with treatment of these fractures in this patient population. Though nonsurgical treatment can be employed in most fractures of the proximal humerus, surgical intervention is recommended for widely displaced fractures. Four general methods of surgical treatment are currently in use: closed reduction and percutaneous pinning, open reduction and internal fixation, hemiarthroplasty, and reverse total shoulder arthroplasty. In this article, we discuss the relative merits and indications, surgical techniques, and outcomes for each of these interventions.