[Objective] To compare the clinical efficacy of minimally invasive deltoid approach and pectoralis major deltoid approach in the treatment of proximal humeral fractures with abduction and insertion.[Method] From January 2017 to December 2019, 61 cases of proximal humeral fractures were treated with open reduction and internal fixation. Among them, 34 cases were treated with deltoid minimally invasive approach (deltoid group), and 27 cases were treated with thoracic third approach (thoracic third group). The perioperative period, complications, and constant scores at 1 month, 3 months and 1 year follow-up were compared between the two groups.[Results] All patients were followed up for more than one year. The total length of incision, intraoperative blood loss, total operation time and bone healing time of deltoid group were significantly better than those of thoracolumbar group (P < 0.05). The constant score of deltoid group was higher than that of chest three group at early postoperative stage (P < 0.05), but there was no statistical significance between the two groups at 1 year after operation (P > 0.05). During the follow-up, there was 1 case of humeral head avascular necrosis (stage III, according to the cruess criteria) and 1 case of cephalic vein injury in the three groups. There was no significant complication in deltoid group. [Conclusion] Compared with the thoracotrigial approach, the deltoid minimally invasive approach has the advantages of less soft tissue damage, early fracture healing, fewer complications, and early functional recovery, which is an advantage method for the treatment of abduction embedded fractures.