Open reduction, internal fixation of proximal humerus fractures are technically challenging procedures. The authors in this study randomized 83 patients at two university trauma centres to the deltopectoral or deltoid split approaches for the fixation of Neer II and III proximal humerus fractures. Outcomes assessed included the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH), the Constant-Murley score, pain, range of motion, and complications. The authors found significantly better functional and pain scores as well as fewer complications in the deltopectoral group. Only range of motion was better in the deltoid split group. The authors conclude that the deltopectoral approach should be used for these fractures.