Six randomized control trials were included in the meta-analysis investigating the efficacy between operative and nonoperative treatment for complex 3- and 4-part humeral fractures. Overall, outcomes were similar between operative and nonoperative treatment, with few differences noted in functional outcome up to 24 months. Operative management required more additional surgery than did nonoperative treatment, and implants demonstrated a significant rate of penetration into joint spaces. Upon sub-group analyses for these findings, differences were in large part due to open reduction and internal fixation; hemiarthroplasty in the subgroup analyses was found to be statistically similar to nonoperative treatment.