Management of a posterior locked fracture dislocation

A 55 year old triathlete fell while bike riding, landing on his outstretched left hand. He developed posterior instability that was treated with a posterior arthroscopic stabilization at an outside facility. Subsequently it was noted that he had developed a locked posterior fracture dislocation with both an anterior humeral and a posterior glenoid defect as shown by the images below.

He elected an open reduction and humeral hemiarthroplasty with an anteriorly eccentric humeral head and a posterior glenoid bone graft using part of the resected humeral head. At surgery his shoulder was very stable under vigorous posterior loading.

The postoperative films are shown below

The plan is for external rotation isometrics and 6 weeks immobilization in a neutral rotation brace.
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