Osteosynthesis of Locked Posterior Impaction Fracture-Dislocation of the Humeral Head: Technical Note

The posterior impaction dislocation fracture of the humeral head is a rare trauma in daily practice. Few articles are published in the literature, most often with small series and various surgical techniques. We describe a technique for osteosynthesis of complex posterior dislocation fractures of the humeral head by double superior-deltoid trans-deltoid approach associated with a vertical posterior approach. We do not recommend a reduction alone with the finger and the use of spacers against elbows, even with foam tips to open up the head. We recommend the use of a graft repellent and osteosynthesis material by self-tapping cannulated screws buried with double screwing on temporary pins associated with a proximal humeral locked plate. The articular approach passing through the posterior portion of the rotator cuff allows joint control. Extensive humeral disinsertion of the rotator cuff is not advised. The placement of a shoulder arthroplasty is an alternative to be offered in the elderly, or in the event of failure or impossibility of conservative surgery