This discussion highlights persistent variability in managing proximal humeral fractures and the need for consistent, evidence-based care. The meta-analysis found no functional or pain advantage of surgery over non-operative treatment, while surgical patients—especially those treated with locked plates—faced markedly higher reoperation risks. Reverse shoulder arthroplasty showed superior outcomes to both non-operative care and hemiarthroplasty in older adults, suggesting a promising but still evolving role. Ongoing multicenter studies aim to clarify treatment pathways for both younger patients needing fixation and older patients who may benefit most from arthroplasty.