The dislocation needs to be reduced as soon as possible to preserve the viability of the humeral head and neurological integrity. Doing so, this procedure is usually combined with an osteosynthesis. A closed reduction may be attempted but it is often unsuccessful. Thus, the need for an open reduction and internal fixation must be remembered.
Operative fixation is the preferred treatment. However, the decision for surgery should also include the functional demands of the patients, the presence of comorbidities, and the ability to undergo operative treatment. All treatment options carry a high risk of avascular necrosis.
Indications for arthroplasty are inability to achieve satisfactory reduction and stable fixation, especially in elderly patients with osteoporotic bone.