A difficult combination: simultaneous humeral head and glenoid defects

We were recently sent the x-rays from the right shoulder of a young person with a shoulder injury. While the AP view appeared to show arthritis.

the axillary 'truth' view showed a posterior fracture dislocation with major loss of anterior humeral bone and posterior glenoid bone.

A CT scan added no additional information

He was treated with a hemiarthroplasty

After an early post operative injury, an axillary view was taken showing displacement of the prosthetic humeral head into the posterior glenoid defect.

We not confident that any surgical procedure will meet the needs of this young active person. In our experience a posterior bone graft is unlikely to withstand the loads that will be put on it by the hemiarthroplasty. A reverse total shoulder could be considered using the residual anterior glenoid bone, but this approach may not be appropriate for a young person with high activity expectations.

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