Proximal humeral fractures account for approximately 4– 5% of all fractures. The incidence of proximal humeral fractures increases exponentially after 50 years of age ,regarding treatment of proximal humeral fractures; much controversy and confusion still exist, and no single treatment protocol or algorithm has been proved to be universally effective, Recently, some new trends have been described for fixation of proximal humerus fractures as PHILOS (Proximal Humeral Internal Locking System) plate, percutaneous cannulated screws], Intramedullary pinning with tension band wiring.transosseous sutures.