Fractures of the proximal humerus account for 4% to 5% of all fractures. Eighty-five percent of these fractures are nondisplaced, but the remaining 15% of fractures are displaced and provide the orthopedist with a therapeutic challenge. Fixation techniques are myriad, and none is ideal for all cases. Current operative approaches such as closed reduction and percutaneous pinning or external fixation have emphasized minimum exposure and rigid fixation, with the objective of preservation of vascularity to the articular segment. Two-part surgical neck fractures without extensive comminution and valgus impacted four-part fractures are best treated with closed or transcutaneous reduction and percutaneous pinning. When extensive cortical comminution or severe soft tissue injury is present, transcutaneous or closed reduction and external fixation provides a useful alternative means for stabilization. In selected two-part surgical neck and valgus impacted four-part fractures, the results from this limited approach are generally better than with open techniques because of better preservation of the articular segment. Complications associated with treatment of proximal humerus fractures using percutaneous pinning or external fixation include avascular necrosis, pin tract infection, loss of fixation or pin migration, malumon, nonunion, and secondary fracturing of the humerus after removal of transfixing pins.