Seventy-three shoulders (66 patients) with posterior fracture-dislocation of the shoulder were treated. Thirty patients were treated during the acute phase. One case was classified as subspinous, and 56 were considered subacromial; 4 cases had posterior fracture-dislocation in three parts, 3 in four parts, and 9 at the anatomic neck. Treatment consisted of closed reduction and immobilization in the emergency department, McLaughlin's procedure, hemiarthroplasty, total shoulder, open reduction with internal fixation, arthroplastic resection, and arthrodesis. Ten shoulders were treated conservatively. The University of California-Los Angeles rating score was used to analyze 56 shoulders during a mean follow-up period of 32.7 months. Good and excellent results can be achieved in those cases that are treated up to 2 years of the lesion; after 2 years results tend to be fair. We do not suggest total shoulder arthroplasty as a treatment option for those surgeons without the necessary expertise.