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Posterior dislocations of the humeral head are rare and often missed on initial presentation. Half of these injuries are associated with an impression fracture of the anteromedial aspect of the humeral head (reverse Hill-Sachs lesion). Several operative strategies have been described to treat this injury, but evidence based management strategies are lacking. We describe a case in which a young and active patient presented with a stiff and painful shoulder following a clavicle fracture 9 months earlier. MRI revealed a locked posterior shoulder dislocation and large reverse Hill-Sachs defect. Anatomic reconstruction of the humeral head was performed using a femoral head allograft to fill the defect. A year later the patient has a good shoulder function without pain or impairments in his daily activities. Posterior shoulder dislocation continues to be a "diagnostic trap". This case reinforces the importance of radiographic axial and transscapular (Y) shoulder views to prevent missing the diagnosis. We state that, even in cases with delayed diagnosis and large humeral head defects, one should attempt to preserve the stability and function of the shoulder joint by restoring the normal anatomy of the humeral head. Femoral head allografting proves to be a suitable option. This case is unique in the combination of injuries, the long diagnostic delay and the encouraging functional results after femoral head allografting.

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