Objective To compare the effectiveness of locking plate combined with minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing in the treatment of proximal humeral fractures in the elderly. Methods The clinical data of 51 elderly patients with displaced proximal humeral fracture treated in our department from January 2018 to January 2019 were collected and analyzed retrospectively. According to the treatment, they were divided into MIPO group (n=29) and intramedullary nailing group (n=22). The perioperative indexes, visual analogue scale (VAS) score at 12 h postoperatively and incidence of complications were compared between the two groups. Constant-Murley scale was performed at 3,6 and 12 months after operation to evaluate the function of shoulder joint. SPSS statistics 13.0 was used for statistical analysis. Student′s t test or Chi-square test was employed for data com-parison between the two groups. Results The two groups both had smaller incision length [(7.3±2.7) vs (7.3±2.6)cm], less amount of intraoperative bleeding [(79.7±25.7) vs (78.3±21.4)ml], shorter operation time [(64.1±17.2) vs (62.5±14.6)min], and lower VAS score at 12h post-operatively [(2.47±0.81) vs (2.44±0.69)], and there was no significant differences between the two groups (P>0.05). No statistical difference was seen in Constant-Murley score between the two groups at 3,6 and 12 months after operation (P>0.05). However, the incidence of postoperative complications was significantly higher in the MIPO group than the intramedullary nailing group [17.24%(5/29) vs 9.09%(2/22), P<0.05]. Conclusion Both locking plate combined with MIPO technology and intramedullary nail fixation can achieve better effectiveness in the treatment of proximal humeral fractures in the elderly. The latter procedure is superior to the former one in the control of complications.