C3.3 fractures have a glenohumeral dislocation with comminuted fractures of the humeral head and/or tuberosities. Many 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 if a reconstruction is not achievable, primary hemiarthroplasty will be the preferred treatment. Nevertheless, especially in younger patients, reconstruction should be attempted.