Implementing the findings from randomized trials in treating patients with shoulder fractures has proven challenging. It can take a decade or more to implement evidence-based practice or de-implement unnecessary or harmful treatments. Randomized trials are powerful tools for detecting differences in effects between treatment groups. However, the number of participants is limited, and the experimental setting may limit the external validity. Randomization helps to eliminate differences between the groups at baseline. Observational studies cannot achieve this, even after adjusting for known confounders. Well-planned large-scale prospective cohort studies, however, can help to document the clinical impact of implementing evidence from randomized trials in everyday clinical practice, thus bridging evidence and practice. In this chapter, I will discuss some barriers to implementing results from randomized trials on shoulder fractures and underline the value of systematic follow-up on all patients regardless of their treatment. To avoid research waste, future randomized trials should be anchored by non-surgically treated control groups and focus on populations or interventions not already covered by published or ongoing trials.