Interest in the fixation of proximal humerus fractures has grown worldwide during the past several years. This change in practice has been driven by several factors, including (1) recognition that humeral head replacement after an acute fracture has an unpredictable outcome; (2) understanding that posttraumatic osteonecrosis of the humeral head is not a clinical disaster; (3) more accurate preoperative imaging using three-dimensional CT scans; (4) improvements in fluoroscopy; (5) refined reduction maneuvers; and (6) improved implants, in the form of contoured locking plates. Despite these advances, clinical results are inconsistent, and the reported rates of surgical complications remain far too high. Most reoperations are due to technical problems that can be avoided with good surgical technique. This chapter focuses on techniques that have proven successful for achieving fixation of these fractures.