A local vascularized scapula bone graft to treat posterior glenohumeral instability-an innovative surgical technique

Posterior glenohumeral instability (PGHI) is a relatively rare functional disability. In cases of significant bony or soft tissue defects, surgical treatment is often unavoidable. Based on the type of defect, a soft tissue procedure, a glenoid reconstruction/augmentation with an allograft, or a combined surgical procedure must be performed. Procedures using avascular allografts from different harvest areas or fresh cadaveric specimens are well established. Nevertheless, in approximately 20% of cases, resorption or aseptic necrosis of the graft leads to recurrent symptoms and repeated glenohumeral dislocation. To overcome this serious disadvantage, vascularized bone grafts should be used.

We introduce an innovative surgical technique using a locally pediculated vascularized bone graft from the scapular pillar to treat PGHI associated with hereditary hypotrophy of the glenoid.

The two-year follow-up of the performed surgical procedure led to a posteriorly stable glenohumeral joint and a persisting vital bone graft. It is an innovative technique supplementing the broad spectrum of surgical techniques to treat PGHI.

Treatment options for PGHI should be selected for each patient individually, considering the causes of instability as well as performing a thorough analysis of the bone stock.