One hundred sixty patients aged 60 years and older with displaced 3- or 4-part proximal humerus fractures were randomized to receive nonoperative treatment (n=54), locking plate fixation (n=52), or hemiarthroplasty (n=54). The primary outcome of interest was the DASH score at 2 years. Secondary outcomes included Constant–Murley Score, Oxford Shoulder Score, quality-of-life measures (EQ-5D and 15D), pain (VAS), and complication rates. Outcomes were assessed at 3, 6, 12, and 24 months. Overall, the results of the study revealed no significant differences between groups in the primary or secondary outcomes. However, the locking plate group had a markedly higher complication (45%) and revision rate (22%) compared with the nonoperative group. The findings suggest that surgical treatment with locking plate or hemiarthroplasty does not provide functional benefit over nonoperative treatment and carries higher risks.