Abstract: [Objective] To analyze the safety and effectiveness of trigen humeral intramedullary nail fixation and locking plate in the treatment of proximal humeral fractures. [Methods] 120 patients with Neer type III and IV proximal humeral fractures treated in our hospital from May 2014 to May 2018 were retrospectively analyzed. The patients in the intramedullary nail group were treated with Trigen intramedullary nail (62 cases), and the plate group were treated with locking plate (58 cases). The observation indexes included perioperative condition, follow-up index and imaging evaluation. [Results] The perioperative indexes and the incidence of adverse reactions in the intramedullary nail group were significantly lower than those in the steel plate group (P < 0.05). At the last follow-up, the shoulder pain, function score, forward lift and neck stem angle of the two groups were significantly improved, and the difference between the two groups was small (P > 0.05). [Conclusion] Trigen intramedullary nail is effective in restoring shoulder joint function and relieving pain symptoms in neer Ⅲ and Ⅳ proximal humeral fractures. It can also effectively avoid the influence of surgical trauma on rehabilitation and reduce the incidence of adverse reactions.