This chapter presents historical techniques for operative fixation of shoulder fractures based on sources from the first decade of the twentieth century. New treatment modalities followed the publication of Röntgen’s On a New Kind of Rays (1896), an innovation almost immediately useful to the practice of diagnostics and preoperative planning. Although internal fixation was not novel, it had previously been limited to subcutaneous fractures and considered risky. But new surgical techniques and implants emerged by the turn of the century, including wires, screws, cerclage, and staples. There was a debate over whether operations on closed shoulder fractures should be performed as a primary procedure or reserved for non-surgical treatment failures. One of the period’s most remarkable figures was the surgical polymath Ernest Amory Codman (1869–1940), a pioneer of skeletal radiology best known for his book The Shoulder, published in 1934. Often celebrated as a book on shoulder fractures, it principally deals with the pathology of the rotator cuff, the short rotators, and the subacromial bursa. Codman’s work on the rotator cuff is the key to understanding his four-part approach to proximal humerus fractures. Codman controversially suggested recording and reporting outcomes for all hospital-treated patients—the end result idea. This idea has yet to be implemented in shoulder surgery a century later.