Abstract

Twenty-seven patients (30 shoulders) presenting with an unreduced posterior dislocation or fracture-dislocation were operated on and followed up for at least 2 years. The lesions were classified in 4 types, after Randelli: posterior dislocation with cephalic fracture inferior to 50 per cent (type I = 10 cases) or superior to 50 per cent (type II = 8 cases) and posterior fracture-dislocations with two fragments (type III = 6 cases) or several fragments (type IV = 6 cases). The first patients of the series underwent a resection of the humeral head (5 cases) or an open reduction (7 cases). During a second period 10 shoulders were reduced by a posterior approach and stabilized by transfer of the subscapularis tendon with or without the lesser tuberosity in the humeral defect 6 shoulders were reduced by an anterior approach together with derotation osteotomy. Lastly, one patient refused to be operated on and we performed a shoulder prosthesis to the last one. Necrosis of the humeral head (9 cases) appeared to be related to the severity of the lesion (type III and IV) and the type of surgical procedure (5 derotation osteotomy out of 6 and 3 open reductions out of 7) rather than to the approach route or the interval from injury to diagnosis. These results show that an anatomical repair may be attempted when the dislocation is less than 6 months old and when the impression defect involved less than 50 per cent of the articular surface. Otherwise and a fortiori in old posterior fracture-dislocations, an arthroplasty seems to be the best solution. Even if it may be clinically difficult, it offers the best chance for a functional shoulder in an active patient.