Many of these injuries have one or more fractures splitting the humeral head. These articular surface splits need to be reduced anatomically and fixed securely for good results and to prevent later glenohumeral arthrosis. The reduction must be confirmed by intraoperative image intensification which is difficult. Obtaining and maintaining reduction of the head-splitting fracture lines is very demanding. In some cases, especially in case of significant osteoporosis or if a reconstruction is not achievable, primary arthroplasty will be the preferred treatment. Nevertheless, especially in younger patients, reconstruction should be attempted.