Treatment of unreduced posterior dislocations of the shoulder

Unreduced posterior dislocations of the shoulder are rare and difficult to treat. Treatment depends of defect of the humeral head. Since 1997 to 2002 eleven patients were referred to us for treatment unreduced posterior dislocations of shoulder with impressed fracture of the humeral head. Dislocations have lasted between two to eight months. All patients were treated with open reduction. Allograft reconstruction of the defect was used in six and hemiarthroplasty in two cases. As assessed with the scoring system of Constant, patients were rated excellent (9), satisfactory (1), unsatisfactory (1). Allograft reconstruction is the optimal choice for defects involving 20% to 45% of the humeral head. Prosthetic replacement is preferred for larger defects. Reconstruction of the defects involving less than 20% of the humeral head is not necessary. The observation is only ment to serve as a guide during decision making. The surgeon must make his own surgical choice based on the individual patient factors and on the intraoperative findings.