Surgeons have a far-reaching responsibility to do no harm and to provide benefits to their patients. Before opting for surgery, the first question to consider is whether the proposed procedure is better than non-surgical or no intervention. Surgical eminence or biomechanical reasoning alone is insufficient to predict differences in the outcome of treatment. Relying solely on non-controlled cohort studies to estimate a treatment’s effectiveness is unreliable. Conducting randomized trials to compare surgical interventions with a non-surgical control group is, then, crucial until benefits have been demonstrated. After demonstrating the benefits, different surgical options can be compared. Despite the great number of publications, most studies on shoulder fractures are non-comparative retrospective series of surgical techniques, usually conducted and evaluated by the authors. Only a small percentage of research studies on shoulder fractures are randomized trials. This chapter introduces current evidence regarding surgical and non-surgical treatments for shoulder fractures by reviewing randomized trials, meta-analyses, and network meta-analyses.