Humeral head fractures are commonly found in elderly patients. A high rate of spontaneous rotator cuff tears in this patient group may endanger good results following surgical treatment. 70 patients > 65 years with dislocated humeral head fractures were prospectively studied and treated surgically following a standardised treatment protocol. In all cases the rotator cuff was examined intraoperatively. A tear of the rotator cuff was documented in 4 cases (5%). The prevalence of rotator cuff tears in elderly patients with dislocated humeral head fractures is significantly smaller than expected referring to magnetic resonance-, sonographic and cadaveric studies of same-age patients without fracture. Therefore the rotator cuff may serve as retention anchor for the surgical treatment of dislocated humeral head fractures in elderly patients.