Difficulty in fully defining the injury, patient characteristics, osteoporosis, technically difficult surgery, the need for carefully supervised physiotherapy, and the realization that a poor initial result is very difficult to reconstruct make the comminuted fracture of the proximal humerus a problem fracture. The literature on this fracture is also incomplete and confusing. The solutions are many and complex: use adequate roentgenograms to understand the traumatic lesion, be careful to avoid denying older patients effective surgical treatment, use a safe and simple surgical approach, know the options for internal fixation, recognize the values of prosthetic replacement, avoid technical pitfalls, and thoughtfully supervise the postoperative patient care.