Background: Proximal humerus fractures are among the most common fractures of the upper extremity, particularly in elderly individuals, due to their association with osteoporosis and low-energy trauma such as falls. To evaluate the functional outcomes of proximal humerus fractures managed by different treatment modalities, including conservative management, open reduction and internal fixation (ORIF), closed reduction with percutaneous pinning, and hemiarthroplasty. Material and Methods: A prospective observational study was conducted on 160 patients aged 18 years or older with radiologically confirmed proximal humerus fractures. Patients were managed based on fracture type, severity, age, and comorbidities. Functional outcomes were assessed using the Constant-Murley and American Shoulder and Elbow Surgeons (ASES) scores at 6 months and 1 year. Statistical analyses were performed to compare outcomes across treatment modalities, with a p-value <0.05 considered significant. Results: The study revealed that ORIF was the most commonly used treatment (40.00%) and achieved the best functional outcomes, with 46.88% and 43.75% excellent results on the Constant-Murley and ASES scores, respectively. Closed reduction with pinning showed favorable outcomes for specific fracture patterns, while conservative management and hemiarthroplasty were associated with higher complication rates and poorer functional recovery. Significant factors influencing outcomes included age, fracture type, treatment modality, and timing of surgery. Conclusion: The choice of treatment modality significantly impacts functional recovery in proximal humerus fractures. ORIF provided superior outcomes in younger patients and simpler fractures, while hemiarthroplasty was effective for complex fractures in older patients. Early intervention and individualized treatment planning are essential for optimizing results.