There are a variety of treatment options for proximal humerus fractures, including nonsurgical management, open reduction and internal fixation with screws, locking plates, intramedullary nailing or suture fixation, and arthroplasty. Fracture characteristics—including the number of fracture parts and involvement of the humeral head and glenoid—and the patient’s functional status and postoperative goals help dictate the optimal choice. Where there is concern about the viability of the humeral head, including head-splitting or depression fractures, or about the ability to achieve an acceptable reduction and secure fixation, arthroplasty is a dependable option. Reverse total shoulder arthroplasty has become a popular option, especially for complex fractures in elderly patients; however, there is still a role for hemiarthroplasty for reliable pain relief in select cases such as younger patients with unreconstructable fractures, patients with an axillary nerve injury affecting deltoid function, and patients with compromised glenoid bone stock not amenable to glenoid resurfacing. This video reviews the case of an active 64-year-old man with an impacted four-part proximal humerus fracture with a small head piece and a comminuted and posteriorly displaced greater tuberosity fragment. The patient’s primary postoperative goal was pain relief, so considering this, the fracture pattern, and the patient’s physiologic age, we proceeded with hemiarthroplasty. The video reviews specific surgical techniques for shoulder hemiarthroplasty, including implant positioning, cementing techniques, tuberosity fixation principles, tensioning of the myofascial sleeve, and postoperative protocols.