Proximal humeral fractures may be treated by joint replacement or internal fixation. We have been concerned by the unpredictable results of hemiarthroplasty in the trauma situation. At The Alfred hospital, we have used the ACE proximal humeral plate over the last three years. This is a retrospective study of 55 cases, looking at the outcome of internal fixation, the incidence of avascular necrosis, and the functional results. The results were very favourable when compared with the results of other series that have been published in the literature. Our conclusion is that it is better to internally-fix these fractures whenever possible.