Case Report: Revision surgery for a missed posterior dislocation of the humeral head in a shoulder fracture-dislocation and literature review

Background Posterior shoulder dislocation is uncommon and therefore prone to being missed. When accompanied by a proximal humeral fracture, complex fracture lines may obscure the radiographic signs of dislocation. Inadequate standardization of the imaging workup may consequently result in inappropriate management and treatment failure. Case presentation We report a young patient in whom posterior shoulder dislocation was missed at the initial assessment because axillary and scapular Y-view radiographs were not obtained and the available imaging was insufficiently interpreted. The dislocation persisted after the index operation. Revision surgery was performed on postoperative day 9 and resulted in a favorable 5-year outcome, with no radiographic evidence of humeral head avascular necrosis or post-traumatic osteoarthritis and near-complete recovery of shoulder function. Conclusion Occult posterior shoulder dislocation should be strongly suspected in patients with complex proximal humeral fractures after high-energy trauma. Obtaining axillary or scapular Y-view radiographs, together with a systematic CT-based assessment, is essential. Even after early treatment failure, targeted revision surgery combined with structured rehabilitation may still achieve a satisfactory long-term outcome in young patients.