[Objective] To compare the clinical outcomes of locking proximal humeral plate (LPHP) versus humeral hemiarthroplasty (HHA) for complex proximal humeral fractures in the elderly. [Methods] A retrospective study was done on 78 elderly patients (≥80 years old) who underwent surgical treatment for complex proximal humeral fractures (Neer type III and IV fractures) from January 2015 to Janu- ary 2018. According to the results of preoperative doctor-patient communication, 46 patients received LPHP for open reduction and inter- nal fixation, while the remaining 32 patients had HHA performed. Clinical documents, such as complications, Neer, ASES and ConstantMurley scores, as well as radiographic data were compared between the two groups. [Results] All the patients in both groups were success- fully operated on without serious intraoperative complications. The HHA group had significantly less intraoperative blood loss and operation time than the LPHP group (P＜0.05) , although there were no statistically significant differences in terms of number of fluoroscopy, postoper- ative blood transfusion, hospital stay and perioperative complications between the two groups (P＞0.05) . All patients in both groups were fol- lowed up for 12~18 months, with an average of (13.87±2.84) months. Adverse events were of 14/46 (30.43%) in the LPHP group, 5/32 (15.63%) in the HHA group, which was not statistically significant (P=0.134) . There were no significant differences in terms of time to re- sume active motion and time to recover full weight-bearing activity between the two groups (P＞0.05) . At corresponding postoperative time points, HHA group had less forward extension ROM, while higher Neer, ASES and Constant-Murley scores than LPHP group, despite of the fact that no statistically significant differences were noticed in the abovementioned items between the two groups (P＞0.05) . Radiographical- ly, the acromiohumeral interval (AHI) and humeral neck-shaft angle (HNSA) remained unchanged significantly in the two groups at the lat-est follow-up compared with those immediately after surgery (P＞0.05) , and there was no statistical significance in AHI and HNSA between the two groups at corresponding time points (P＞0.05) . By the time of the latest follow-up, 9 patients presented loosening or perforation of screws, 5 cases had ischemic necrosis of the humeral head, and 11 cases had poor fracture union, including nonunion and delayed fracture union in the LPHP group, whereas 3 patients had periprosthetic fractures and 2 had poor healing of humeral greater trochanter in the HHA group. [Conclusion] Both LPHP and HHA do achieve reasonable clinical outcomes for complex proximal humeral fractures in the elderly. By comparison, the HHA is more conducive to early rehabilitation exercise and improvement of shoulder joint function.