Currently, proximal humerus fractures make up 7% of all fractures and 80% of all humerus fractures. In patients older than 65, proximal humerus fractures make up more than 10% of all fractures and are the third most common non-vertebral osteoporotic fracture following fractures of the distal radius and proximal femur. There are a variety of treatment options for proximal humerus fractures, including non-operative management, percutaneous pinning, screw osteosynthesis, plating, intramedullary nailing, and arthroplasty (hemi, total, and reverse). While many of the elderly can be treated non-operatively, those meeting operative criteria are offered our preferred management: open reduction internal fixation with a proximal humeral locking plate. We aim to outline our technique and provide a stepwise approach in order to achieve an optimal clinical result.