Only 5% of adult fractures are fractures of the proximal humerus. In 80% of these fractures one can expect a good result, because they are generally nondisplaced, stable and allow early mobilization. However, the other 20% of these fractures present not only problems with reduction and adequate fixation but also the risk of humeral head necrosis and painful shoulder ankylosis. The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration the great extend and the biological aspects of these fractures and provides sufficient stability for early functional therapy. The Neer-classification has proved very useful for both, the indication for and the choice of an operative procedure.