According to Horak and Nilsson, 5% of all fractures of the human body are fractures of the proximal humerus. Palvanen et al reported an increase in these fractures of more than 3-fold between 1970 and 2002. Court-Brown et al found that 70% of all 3and 4-part fractures are seen in patients aged over 60 years and 50% in patients aged over 70 years. These results indicate that poor bone quality or even advanced osteoporosis will be found in the majority of patients with humeral head fractures. Conservative treatment of displaced fractures has not shown consistently satisfactory results. Reconstructive surgery with locked plating has shown good results in younger patients but was accompanied by a high complication rate in older patients with poor bone quality. Hemiarthroplasty was seen as the treatment of choice for a long time, but it is associated with a high rate of malunion of the tuberosities, which is responsible for poor functional outcome. The malunion rate has been reported to be even worse in older patients. To date, new prosthetics specially designed for fracture care have not improved the healing rate of the tuberosities. From the literature, it can be summarized that better outcome in terms of function can be expected with reconstructive surgery than with prosthetic replacement, despite the high complication rates of both procedures. Unfortunately, most articles compare