Management of posterior fracture-dislocations of the shoulder.

Posterior fracture-dislocation of the shoulder is rare. Comprehensive treatment guidelines for posterior fracture-dislocation of the shoulder with fracture of the humeral head have not been previously published. Although open reduction and internal fixation of the proximal humerus for posterior fracture-dislocation has been reported in several series, the successful reconstruction of the articular surface by rigid internal fixation of a large osteochondral fragment has not been reported. This paper describes two cases of posterior fracture-dislocation of the shoulder with a substantial defect of the anteromedial humeral head resulting from the cleavage of a large osteochondral fragment. Preoperative computed axial tomographic (CAT) scanning of the injured shoulders helped in operative planning by precisely defining the extent of the articular injury. Accurate reconstruction of the articular surface restored joint stability and gave excellent clinical results. Large humeral head osteochondral fracture fragments require accurate reduction and internal fixation.