Objective. Locking blade nail (LBN) represents a new technique that arises from better knowledge of the critical factors that stabilize a proximal humerus fracture. After 3 years of LBN practice, we examined outcomes achieved with the LBN technique compared to the previous prevailing use of plating and screw. Methods: Over 7 years, 332 patients with 2-3-4 part fractures (Neer Classification) were surgically treated. We created 2 groups: A (n = 104) treated with intramedullary LBN nail and B (n = 104) treated with a Philos plate. VAS, SF-36 Scale and Constant Score (CS) were assessed at 1, 3 and 6 months after surgery. Results. Active range of motion and CS showed no significant difference between the two groups for patients with less than 75 years (p > 0.05). In 4-part fractures and elderly patients (> 75 years), LBN showed better results in terms of active range of motion and pain. Six months after surgery, 84.6% (group A) and 73% of patients (group B) had a CS > 80 points and no patient showed persistence of pain (VAS scale). Conclusions. In our experience, use of LBN has led to satisfactory results and a very few cases of complications, even if surgery was performed by different surgeons and on a population that differed in age, comorbidities and severity of humeral fracture.