Abstract: Objective To compare the clinical outcomes and complications between hemiarthroplasty (HA) and locking compression plate (LCP) with fibular allograft in treatment of older patients with comminuted proximal humerus fracture (PHF). Methods From January 2010 to December 2013, a total of 49 older patients with displaced PHF who were treated by HA (n=20) or LCP with fibular allograft (n=29) were included in our study. Function outcomes were assessed by the disability of the arm, shoulder and hand(DASH) score, constant-murley score (CMS), and complications were also recorded in each group. Results There was no significant difference in age, sex, mechanism of injury, and bone mineral density (all P> 0.05). The average follow-up was 63.2 months (range, 48-72 months) in HA group and 60.5 months (range, 48-72 months) in F-LCP group. CMS score in F-LCP group was significantly higher than that in HA group (70.3±13.9) vs (57.3±12.7), P=0.004, while there was no significant difference in DASH score between the two groups. Range of motion (ROM) in F-LCP group was significantly higher than that in HA group (22.5±8.9) vs(15.3±3.1), P=0.034. In F-LCP group, one case had screw perforation, and one with developed avascular necrosis (AVN). In HA group, one patient developed infection, four patients had shoulder stiffness, and one patient suffered from tuberosity migration. Conclusion The present results show that patients treated by LCP with fibular allograft have better functional outcomes and lower complication rates compared to patients treated by hemiarthroplasty.