Objective: To observe the clinical effect of artificial humeral head replacement in the treatment of comminuted proximal humeral fracture in the elderly. Methods: 34 cases of single or bilateral proximal humeral comminuted fractures were treated with artificial humeral head replacement, corresponding nursing measures were taken, combined with anti osteoporosis treatment and functional exercise were guided; neer score and Constant score were used to evaluate the postoperative effect. Results: all patients were followed up for 3-18 months, and the shoulder joint function was evaluated before and after operation for 3, 6, 12 and 18 months. During the follow-up, the excellent and good rate of neer score was more than 85% in 34 patients, and the difference of Constant score (including pain, activities of daily life, active range of activity, muscle strength assessment) was statistically significant (P < 0.05). Conclusion: the replacement of artificial humeral head is an effective method for the treatment of comminuted fracture of proximal humerus in the elderly.