Complex injuries of the shoulder require differentiated management. Interestingly there is a relative lag of warranted information on this subject. Generally the different lesions are discussed separately. However it is not acceptable to simply add the standard diagnostic and therapeutic measures, because major tactic, strategic and rehabilitation incompatibilities could occur. Diagnostic and therapeutic difficulties are frequent for the following injuries: complex proximal humerus dislocation fractures, dislocation fractures with associated lesions of the rotator cuff, posterior dislocation fractures, peri- and intraarticular segmental fractures and fractures or dislocations associated with major neurovascular lesions. Increased awareness of the most relevant diagnostic and therapeutic aspects should contribute to optimize treatment protocols.