Posterior dislocation fractures of the humerus occur as impression fractures of the humeral head (reverse Hill–Sachs fracture) and posteriorly dislocated proximal humeral (PH) fractures with a subcapital component. This study evaluated fracture patterns, current treatment, and revision rates. Data of patients who underwent surgical treatment for PH dislocation fractures in two level-I trauma centers between 2010 and 2018 were retrospectively reviewed. We identified 41 shoulders in 37 patients (n = 12 female, n = 25 male; average age 52 [25–91] years) with open surgical treatment of PH posterior dislocation fractures. In 14 patients, the cause was convulsive seizure or electrical accident, in 23 patients, a fall or high-energy trauma. There were 22 shoulders with impression fractures without a subcapital aspect; 19 shoulders had a posteriorly dislocated subcapital fracture. All patients were treated surgically via a deltopectoral approach. Five of the impression type fractures were treated prosthetically; the other 17 impression type fractures had humeral head-preserving reconstruction. The 19 cases of subcapital dislocation fractures were treated with open reduction and internal fixation with a PHILOS plate (n = 13) or with a prosthesis (n = 6). Within a mean follow-up period of 4.3 (1–9) years, the overall revision rate was 15% (6/41). Four patients underwent elective arthroscopic capsulotomy and implant removal. Two patients required revision surgery due to loss of reduction or humeral head necrosis. Impression type fractures were slightly more common than posteriorly dislocated PH fractures with a subcapital fracture component. In 73% of cases (n = 30), humeral head-preserving reconstruction was performed. The overall mid-term revision rate was 15% with a low-rate of secondary conversion to total shoulder arthroplasty (3%). Longer term functional outcomes of the patients are needed to better evaluate the treatment concept.