Open reduction through a posterior incision in the surgical treatment of shoulder posterior dislocation associated with proximal humeral fractures.

Background: We explored the surgical technique of reducing the humeral head and repairing the fractures through a combined approach in the treatment of this complex injury.

Methods: Six patients with posterior shoulder dislocations associated with proximal humerus fractures were enrolled in this study. The posteriorly dislocated head was first reduced through a shoulder posterior incision and the ruptured posterior capsular tissues were repaired simultaneously using a suture anchor. The fractures were then reduced and fixed with a PHILOS through a deltopectoral approach. The affected shoulders were immobilized in a neutral position for 6 weeks postoperatively with a customized orthosis and then permitted active shoulder exercises after removal of the orthosis. At the last visit, union of the fractures was evaluated. Degrees of anterior forward of the affected shoulder were recorded. Outcomes were evaluated according to UCLA and Constant criteria.

Results: Six patients were followed up for an average of 24.5 ± 7.4 (range 13-35) months. At the last visit, the mean degree of anterior forward was 171.7 ± 7.5 (range 160-180) degrees. An average of 32.9 ± 1.2 (range 31-34) points was obtained according to UCLA criteria, demonstrating excellent and good results in two and four cases, respectively. The mean Constant score was 87.3 ± 4.1 (range 83-92) points.

Conclusions: The dislocated humeral head can be reduced through a posterior approach, while fractures can be reduced and fixed through a deltopectoral approach. This technique has the advantages of simplicity and its minimally invasive approach for reducing the dislocation.