Posterior dislocation of the shoulder may be associated with an anteromedial impaction fracture rendering the shoulder unstable in internal rotation. The modified McLaughlin procedure as described by Neer involves transplanting the lesser tuberosity with the attached subscapularis tendon into the anteromedial defect. We have used this procedure acutely (from the day of injury to 10 days postinjury) in seven shoulders. All patients were unstable in internal rotation and had an anteromedial impaction fracture occupying 25-40% of the articular surface. This technique provides good stability, enables immediate active range of motion, and allows the patient to rapidly return to activities of daily living.