Arthroscopic treatment of acute traumatic posterior glenohumeral dislocation and anatomic neck fracture.

We describe a simple method of arthroscopic-assisted reduction of a posterior fracture dislocation of the proximal humerus, the principle of which could be used as a method of reduction for all fracture dislocations of the proximal humerus for which percutaneous reduction is beneficial. With the patient in the beach-chair position and using a posterior portal 2 cm medial and 2 cm inferior to the posterolateral corner of the acromion on the medial edge of the displaced head, a 4.5-mm blunt trocar is introduced, directed medial to the head fragment toward the posterior lateral scapular neck, translating the distal tip laterally to enter the shoulder joint. The trocar is then redirected medially onto the articular surface of the glenoid and the head is levered into the joint atraumatically. The standard technique of percutaneous reduction of the proximal humerus follows. Arthroscopic evaluation of the shoulder with gravity-assisted flow is performed to improve the articular reduction and document any associated capsular, ligamentous, labral, or tendon damage. Similarly, anterior fracture dislocations can be reduced atraumatically using lateral and anterior portals, after which percutaneous reduction could be effective when indicated.