Abstract Objective: Displace three- or four-part proximal humerus fracture were severe damages,and the treatment for displaced proximal humeral fractures is still have no consensus,this study aimed to investigated the clinical outcomes between plate and shoulder hemi-arthroplasty for displace four-part proximal humerus fracture in elderly patients. Methods: Since January 2015 to April 2018,totally 49 elderly displace three- or four-part proximal humerus fracture patients,all patients were older than 60 years,19 patients accepted shoulder hemi-arthroplasty(HA) and 30 patients received locking compression plate surgery(LCP).Operation time,total blood loss,post-operative haemoglobin, transfusion requirements,the length of hospital stay and complications were recorded as primary outcomes, at final 12 months follow-up,Constant-Murley score (CMS), Disabilities of the Arm, Shoulder and Hand (DASH) score and VAS were evaluated as second outcomes. Results:All patients have completed more than 12 months follow-uo,compare with LCP,HA group have significant shorter the operation time and the length of hospital stay but more haemoglobin drop.In addition,3 and 5 patients received transfusion respectively in HA and LCP group,and both group have no critical complication incident.At final follow-up,LCP patients achieved better CMS,DASH outcomes,the VAS have no statistics difference between two groups. Conclusion: Our results suggest that compare with LCP,HA can shorter the operation time and increase hospital stay days,haemoglobin drop;but LCP have better shoulder function recovery.