The surgical management of posttraumatic arthritis is one of the most difficult problems encountered in shoulder surgery. Bone and soft tissue abnormalities resulting from the initial injury and from any subsequent surgery must be addressed to achieve the best outcome possible. A review of the literature reveals distinctly inferior results and a higher rate of complications following surgical treatment of posttraumatic sequelae compared with the surgical treatment of acute proximal humeral fractures. The authors present helpful hints for dealing with the complex problems encountered in the posttraumatic setting.