The complications of old fractures of the proximal humeral head and fracture dislocations are nonunion, malunion, osteonecrosis, early traumatic arthritis, chronic dislocation and instability with subluxation. We reviewed a consecutive series of 34 shoulders that were treated between 1986 and 1990. We performed 7 hemiarthroplasties and 11 total shoulder arthroplasties (Neer type) in 17 patients (group I). Group II consisted of 12 osteotomies, 3 internal fixations for nonunion (AO technique), and 1 shoulder arthrodesis. The average follow-up was 27 months (group I) and 26 months (group II), respectively. The results were: good in 32%, fair in 50%, and poor in 18% in group I; excellent in 6%, good in 62%, and fair in 32% in group II. The results indicate that varus/valgus-osteotomies and derotation osteotomies should be considered as an alternative procedure prior to arthroplasties before traumatic arthritis has developed. Internal fixation for nonunion (AO technique) is a replacement for hemiarthroplasty.