Aims: To compare retrospectively the results of percutaneous þxation, open reduction and þxation and hemi-arthroplasty in displaced proximal humerus fractures. Methods: The initial study group lost 29.50% of patients to follow-up and registered 14.75% deaths. Finally, 98 patients came back for revision and were included in the study with an average follow-up of 41 months. The hemi-arthroplasty group (H) included 34 patients, the percutaneous group (P) 32 and the internal þxation (I) 32. The average age was 55 for P group, 58 for I and 72 for H. Females represented 62% of P, 50% of I and 79% of H. Low energy fractures accounted for 62%, 63% and 78% respectively. Comorbidity in H was present in 50% of cases and associated fractures in 28%. Three and four part fractures following Neer classiþcation were present in 55% P, 55% for I and 100% for H. Results: Average elevation was 130û for P, 106û for I and 80û for H patients. Selecting only three and four part fractures, elevation was 105û in P, 104û in I and 80û in H. Constant score reached in average 81 points in P, 68 in I and 57 in H. For three and four part patients mean Constant was 74, 68 and 57 respectively. VAS with daily activities was 0.6 for P, 2.3 for I and 3.8 for H. Good and average radiological reduction was achieved in 55% of P and I groups and 12.5% osteonecrosis developed in I but none in P. Conclusions: Percutaneous þxation represents a good surgical option comparable to open reduction and þxation. Hemiarthroplasty only achieves modest functional results but patients have quite different epidemiological data.