Clinical and Functional Outcomes of Posterior Shoulder Fracture-Dislocation: A Retrospective Case Series

Background Posterior shoulder fracture-dislocation (PSFD) is a rare and often misdiagnosed condition, lacking standardized treatment guidelines. Both conservative and operative approaches are used, but long-term stability outcomes remain unclear. This study evaluates the functional and stability outcomes in patients treated for PSFD using the Oxford Shoulder Instability Score (OSIS) and range of motion (ROM). Methods This case series includes 22 patients (26 shoulders) diagnosed with PSFD at University Hospitals Birmingham between January 2020 and December 2024. We retrospectively analyzed patients treated either conservatively or operatively based on fracture severity and surgeon preference. Functional outcomes were assessed at the most recent available follow-up using the OSIS and ROM, including abduction, flexion, and external rotation. Regression analysis was performed to evaluate the relationship between ROM parameters and OSIS using standard software, with statistical significance set at p < 0.05. Results A total of 26 shoulders were treated. Nine shoulders (34.6%) underwent closed relocation followed by physiotherapy, while 17 (65.4%) required surgical intervention, including open reduction internal fixation (three shoulders; 11.5%), arthroplasty (five shoulders; 19.2%), and the modified McLaughlin procedure (nine shoulders; 34.6%). Outcomes were assessed using the OSIS and ROM at follow-up visits and through telephone consultations. The average OSIS score was 35.69 (range: 10-48). ROM assessments showed a mean abduction of 91.82° (range: 20-180°), flexion of 100.91° (range: 20-180°), and external rotation of 35.68° (range: 10-60°). Conclusions Both conservative and operative treatments led to improved functional outcomes, with the modified McLaughlin procedure showing favorable results in maintaining shoulder stability and function. The OSIS provided valuable insight into recovery. Despite variability in ROM, overall outcomes were satisfactory. These findings support individualized treatment approaches, although further multicentric studies with larger sample sizes are required to refine treatment guidelines.