Displaced proximal humeral fractures can lead to significant sequelae if not treated properly. Controversy has existed as to whether these injuries should be treated with or without surgery and if treated surgically with internal fixation or arthroplasty. The dramatic outcomes of surgical treatment have led to increasing use of various treatment alternatives. Each treatment alternative has included a fair proportion of failures, which have required revision. These failures and the increasing demand for normal function have lead to increasing debate as to the most appropriate procedure. Our themes section will discuss this important issue in detail.