Posterior fracture dislocation of the shoulder is rare injury. Treatment is challenging especially for a complex type fracture dislocation with delayed presentation or a reverse Hill-Sachs lesion. We reviewed the surgical approaches, the reduction and fixation techniques, management of reverse Hill-Sachs lesion, pitfalls, and outcomes. We also shared our experience in treating a short case series of posterior fracture dislocation of the shoulder. There were no major complications such as wound infection, nerve palsy, non-union or avascular necrosis of the humeral head in our patients. All could cope with the original activities and had satisfactory recoveries of shoulder functions. The anterior deltopectoral approach alone had some limitation especially in the delayed cases and with complex fracture dislocation. The Utility approach was noted to be a versatile approach for the chronic or delayed cases.