Joint-preserving reconstruction of an acute Type IV reverse Hill–Sachs lesion following posterior shoulder fracture-dislocation: a case report

Abstract

Posterior shoulder fracture-dislocation is a rare injury frequently associated with delayed diagnosis because of its subtle clinical and radiographic presentation. Management is primarily determined by the size of the reverse Hill–Sachs lesion, with shoulder arthroplasty generally recommended for extensive humeral head defects. We report the case of a 39-year-old man presenting with an acute posterior fracture-dislocation of the proximal humerus associated with a Type IV reverse Hill–Sachs lesion. Despite the severity of the injury, the patient underwent successful joint-preserving reconstruction using open reduction and internal fixation with cannulated screws, structural bone grafting, and a modified McLaughlin procedure. At 3-month follow-up, clinical and radiographic evaluation demonstrated a stable glenohumeral joint, satisfactory shoulder function, and painless range of motion. This case suggests that, in carefully selected young patients with reconstructable fracture fragments, anatomical reconstruction may represent a feasible alternative to primary shoulder arthroplasty while preserving native bone stock and future surgical options.