Arthroscopically-Assisted Percutaneous Fixation of a Posterior Fracture Dislocation of the Proximal Humerus

Posterior fracture dislocation of the proximal humerus is a rare and potentially complicated injury. Several authors have advocated treatment with open reduction and rigid internal fixation through various approaches. However, open reduction increases the risk of damaging the already tenuous blood supply to the head fragment, leading to osteonecrosis. Consequently, others have advocated a trial of closed manipulation. Unfortunately, this makes it more difficult to achieve and maintain an accurate reduction. I would advocate the use of arthroscopy during manipulation. A standard posterior portal provides easy visualisation to guide both the reduction of the fracture and the placement of percutaneous fixation with threaded wires.