Shoulder arthroplasty has emerged as a reliable treatment for displaced or comminuted fractures of the proximal humerus. The outcomes of humeral head replacement have improved as technology and techniques have evolved. Reverse shoulder arthroplasty has yielded promising results in early investigations. With either type of instrumentation, meticulous surgical technique is critical to achieving a good outcome. Prosthesis height and version and the stable fixation of anatomically reduced tuberosities are essential variables. Shoulder arthroplasty for fracture treatment remains a technically challenging procedure that demands knowledge of shoulder anatomy and implant options.