Challenge of the Week / Shoulder / 09.27.19

A 21-year-old male patient who is a football player had recurrent shoulder dislocations during the football season and now presents seeking treatment for his shoulder instability. A computed tomography scan with 3-dimensional reconstruction demonstrates > 40% glenoid bone loss. Which of the following would be an ideal treatment option for this patient?
  • Open Bankart repair
  • This patient needs a bone graft procedure and open Bankart repair is not appropriate for him.

  • Arthroscopic coracoid transfer
  • Arthroscopic or open coracoid transfer procedures are indicated for bone loss of 15% to 35%. Bone loss greater than that that should be addressed with other bone graft options such as an iliac crest autograft or a distal tibial allograft.

  • Open coracoid transfer
  • The width of the coracoid is 33% to 35% of the glenoid width and bone loss of >35% should be addressed with other bone graft options, such as an iliac crest autograft or a distal tibia allograft.

  • Open iliac crest autograft
  • An open iliac crest autograft allows for restoration of large glenoid bony defects that cannot be addressed with a coracoid transfer.

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