What is the recommended management for irreducible shoulder dislocation?

• A. Open reduction and stabilization; surgical planning if recurrent or unstable
• B. Closed reduction only
• C. Immediate rotator cuff repair
• D. Immobilization for months without reduction

Answer: (A)

When a shoulder dislocation cannot be reduced with closed techniques, open reduction is needed because soft tissue or a bony fragment can be interposed and prevent relocation. Opening the joint lets the surgeon visually remove any obstructing tissue and directly address damaged stabilizers such as the labrum and capsule. After the humeral head is reduced, the focus shifts to restoring stability; if there is persistent instability or significant bone loss, a definitive stabilization procedure is planned (for example, repairing a labral lesion, addressing a Hill-Sachs lesion with remplissage, or performing a bone-block procedure like Latarjet if glenoid bone loss is present). Immobilizing for months without achieving reduction would leave the joint unreduced and is not appropriate. Routine rotator cuff repair is not the initial approach unless a tear is present that requires it.