Proximal humeral fractures are very common, especially among elderly people with osteoporosis. The treatment methods are numerous, according to the characteristics of the patient and the fracture, as well as the surgeon's preference. These fractures can be treated either conservatively or operatively with closed or open reduction and internal fixation, or arthroplasty. During the past decades, with the advances in osteosynthesis and the establishment of locking plates, many surgeons prefer managing humeral fractures with open reduction and internal fixation with locking plates. Even though this is a widespread method of treatment, many studies report high complication rates, including perioperative and hardware complications. This article presents the most common complications a surgeon may face when managing this kind of fractures, as well as intraoperative techniques that can be used to avoid them.