Eight randomized controlled trials were included in this meta-analysis comparing four different treatment options for 3- and 4-part humeral fractures in elderly patients: nonoperative management, open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (rTSA). The body of literature allowed comparison of rTSA to only HA, while nonoperative treatment, ORIF, and HA were all compared directly to each other. Pairwise comparisons identified four statistically significant differences in analyses; nonoperative treatment was favoured over ORIF when rates of adverse events and additional surgery were analyzed, while reverse total shoulder arthroplasty was favoured over hemiarthroplasty when functional outcome and rate of adverse events were analyzed.