Furthermore, the most commonly used classification of the proximal humeral fractures proposed by Neer , groups fracture dislocation of gleno-humeral joint in single class VI, and this classification does not facilitate decision making how to approach the dislocation in acute setting Khitish Mohanty. Habermeyer’s modification of the Neer classification  describes more specifically the pattern of fractures that is associated with a dislocation, but again this classification has little correlation with decision making and planning how to manage a fracture dislocation in emergency room (Fig. 1) Khitish Mohanty.It must be appreciated that fracture dislocation of the shoulder is not common , and there are only small case series reported in the literature on outcomes of those injuries. They happen more frequently in older patients, where the bone quality is diminished and the risk of fracture propagation may be significant Khitish Mohanty. Hersche and Gerber  describe case series of seven such cases when attempted reduction lead to complete displacement of the fracture, and the humeral head fragment was retained in axilla (Fig. 2). This can have disastrous consequences with possible vascular insult to limb and long-term risk of avascular necrosis of the head fragment Khitish Mohanty.