Because of the scarcity of cases treated with internal fixation by the authors, this chapter is editorially abridged. We also want to remark that the classification of the fractures of the segment 11- is the most debated and the one with less consensus of the Comprehensive Clasification of Fractures, and it will probably be modified in the future.

These are fractures of the proximal humeral segment. Altogether they represent a 2.95% of the total series of surgically treated fractures that we have reviewed.

Traditionally, these fractures have been treated by conservative methods since, because the shoulder is not a weight bearing joint and it is the most mobile joint of the skeleton, non-anatomic reductions are compatible with an acceptable function. On the other hand, healing is usually fast allowing early articular motion, a determinant factor of the functional result. The “scapulo-thoracic joint” can compensate for the gleno-humeral motion loss but it is the residual pain what determines the result. This is probably why in the last decade there is an increasing trend towards surgical reconstruction indications in some cases, specially in young patients, with good results for some of the fracture types A and B. Reconstructive surgery is discouraging in the majority of the type C subgroups; this is why there is a progressive tendency towards the prosthetic replacement in these cases, which results will have to be evaluated with the test of time.