Locally delivered rhBMP-2 enhances bone ingrowth and gap healing in a canine model.

The purpose of the present study was to determine if recombinant human bone morphogenetic protein-2 (rhBMP-2) enhances bone ingrowth into porous-coated implants and gap healing around the implants. In the presence of a 3-mm gap between the implant and host bone, porous-coated implants were placed bilaterally for four weeks in the proximal humeri of skeletally mature, adult male dogs. In three treatment groups, the test implant was treated with HA/TCP and rhBMP-2 in buffer at a dose of 100 microg/implant (n=5), 400 microg/implant (n=6), or 800 microg/implant (n=5) and placed in the left humerus. In these same animals, an internal control implant was treated only with HA/TCP and buffer and placed in the right humerus. These groups were compared with a previously reported external control group of seven animals in which no growth factor was delivered [J. Orthop. Res. 19 (2001) 85]. The BMP treated implants in the two lower dose groups had significantly more bone ingrowth than the external controls with the greatest effect in the 100 g/implant group (a 3.5-fold increase over the external control, p=0.008). All three dose groups had significantly more bone formation in the 3-mm gap surrounding the BMP treated implants than the external controls with the greatest effect in the 800 microg group (2.9-fold increase, p<0.001). Thus, application of rhBMP-2 to a porous-coated implant stimulated local bone ingrowth and gap healing. The enhancement of bone formation within the implant (bone ingrowth) was inversely related to dose.     

肩关节不稳定的肩盂骨缺损评估:肩盂下部圆心的确定

目的 探讨在正常肩盂CT三维重建标准正面观影像上确定肩盂下部圆心的可行性,比较同一个体左、右肩盂的半径大小,为术前精确定量评估肩盂骨缺损比例提供影像学依据. 方法 本研究测量了35例成人双侧正常肩盂(共70个),每个肩盂均行64层螺旋CT扫描,由1位医生在三维工作站上获得肩盂的标准三维正面观影像及标尺,并将其以二维图像的格式导出.3位医生分别利用AutoCAD2006软件对图像进行处理,做肩盂下部前缘最突点、下缘最突点连线的垂直平分线,再做后缘最突点、下缘最突点连线的垂直平分线,将两垂直平分线的交点定为肩盂下部的圆心,分别测量该点到肩盂前下缘、后下缘和后缘的距离.比较3位医生测量的圆心到肩盂前下缘、后下缘和后缘距离值,以及左、右肩盂相应距离的测量数据. 结果 肩盂下部圆心到肩盂后缘最突点之间的距离(即圆的半径)为(14.1±1.6)mm,到肩盂前下缘的距离为(14.0±1.7)mm,到肩盂后下缘的距离为(14.1±1. 6)mm.3位医生测量的圆心到肩盂后缘距离值之间及左、右肩盂相应测量值之间差异均无统计学意义(P>0.05). 结论 在正常肩盂的CT三维标准正面观影像上利用肩盂下部前、后、下缘最突点确定肩盂下部圆心的方法是简便、可行的,可重复性较高.正常人左右肩盂下部的半径是一致的.以上结论可用于单侧肩盂骨缺损的精确定量评价.     

Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients

Aim

Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures.

Patients and methods

We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9 ± 5.57 years (age range: 59–81 years). The mean follow-up period was 78.8 ± 26.6 months (range: 48–118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfaction and functions, according to the Constant and Murley Scoring (CMS) system.

Results

We found good-to-excellent outcomes in 36 (85.7%) and poor outcome in six (14.3%) patients according to the Neer criteria. The average values for CMS score, anterior elevation and external rotation were 73.59 ± 17.95 (25–94), 121.30 ± 42.99° (range: 30–170°) and 30° (range: 0–80°), respectively. The patients who had been operated in the early period (within 2 weeks) had better functional outcomes (p < 0.001) and had significant pain relief. There was a strong positive correlation between the humeral offset (distance between the head and the tuberosities) and the degree of elevation (r = 0.872, p < 0.001). There was a strong negative correlation between the height of the humeral head and the degree of elevation (r = −0.853, p < 0.001).

Conclusion

In humeral proximal end fractures, primary hemiarthroplasty in the early period with the anatomic reconstruction of bone and soft tissues of the shoulder joint and long-term regular rehabilitation programme are important factors contributing to increased patient satisfaction.     

The effect of intramedullary polymethylmethacrylate on healing of intercalary cortical allografts in a canine model.

The purpose of this study was to evaluate the effect of intramedullary polymethylmethacrylate (PMMA) bone cement on the healing of intercalary allografts. Thirteen adult beagles had bilateral intercalary femoral allografts implanted. The medullary canal of one randomly assigned allograft in each dog was filled with PMMA. Healing was followed clinically and femora were evaluated radiographically, biomechanically, histologically, and histomorphometrically 9 months after surgery. There was an increased percent of eroded surface at the endosteal area of the center region of grafts containing PMMA and there was an increased percent osteoblast surface in this area in grafts not containing PMMA. There was an increased percent eroded surface at the periosteal area in the center region in grafts not containing PMMA and there was an increased percent osteoblast surface at the periosteal area in the graft adjacent to the host junction in grafts containing PMMA. There was no significant difference between PMMA-treated and untreated allografts in any other parameters measured. The results from this study suggest that, although the pattern of incorporation is altered, intramedullary PMMA does not appear to effect allograft healing adversely.     

Mixed-reality holographic-assisted placement of glenoid guidewire in shoulder arthroplasty: preliminary comparison to patient-specific instrumentation in B2 glenoid model

BackgroundThree-dimensionally (3D) printed patient-specific instrumentation (PSI) guides and computer navigation are 2 forms of commercially available options for improved accuracy of glenoid guide pin placement during shoulder arthroplasty. Mixed reality (MR) and virtual reality devices have been used in medical education thus far, but there has been limited assessment of their intraoperative viability in specific settings such as shoulder arthroplasty. The purpose of this study was to compare the accuracy of MR holographic model–assisted glenoid guidewire placement to freehand (FH) and PSI options.MethodsSixty 3D printed glenoid polyurethane sawbones models with a B2 glenoid defect were created. The 3D model of the B2 glenoid with a guide pin in place was programmed into a Unity-based application installed on the Microsoft HoloLens2 MR device. In randomized fashion, 5 surgeons placed a guide pin into the “sawbones” models using FH, PSI, or MR with the attempt to replicate the desired preoperative plan. Using fine-cut computed tomography, average version, average inclination, and starting point were analyzed among all models and surgeons.ResultsThe average starting point from the plan for the FH group was 2.21 ± 0.95 mm, 2.27 ± 0.80 mm for the PSI group, and 1.745 ± 0.84 mm for the MR group, P = .12. The average inclination was 10.56 ± 7.37 degrees, 3.02 ± 3.36 degrees, and 8.16 ± 5.69 degrees for the FH, PSI, and MRI groups, respectively, P = .0004. The average version was 13.52 ± 9.21 degrees, 7.26 ± 4.64 degrees, and 12.36 ± 9.19 degrees for the FH, PSI, and MRI groups, respectively, P = .04. Subgroup analysis of FH to PSI and PSI to MR demonstrated significantly less inclination from plan in the PSI group, P = .0003 and P = .02, respectively. There were no differences in version in the subgroup analysis between the FH and MR and PSI and MR groups. Degrees of deviation of inclination from plan were significantly less when comparing all models among more experienced surgeons, P = .026, whereas no statistical differences in deviation of start point or version were noted across all models in the more experienced group. When further analyzing the inclination among the FH, PSI, and MR groups among higher level surgeons, the PSI model demonstrated less deviation from plan compared to the FH model, P = .02, but there were no differences in inclination when comparing the PSI to MR and MR to FH models.ConclusionMR permits accurate glenoid guide pin placement comparable to FH placement in a polyurethane B2 glenoid bone substitute model.     

Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial

Purpose

The treatment of choice for a displaced femoral neck fracture in the most elderly patients is a cemented hemiarthroplasty (HA). The optimal design, unipolar or bipolar head, remains unclear. The possible advantages of a bipolar HA are a better range of motion and less acetabular wear. The aim of this study was to evaluate hip function, health related quality of life (HRQoL), surgical outcome and acetabular erosion in a medium-term follow-up.

Methods

One hundred and twenty patients aged 80 or more with a displaced fracture of the femoral neck (Garden III and IV) were randomised to treatment with a cemented Exeter HA using a unipolar or a bipolar head. All patients were able to walk independently, with or without aids, before surgery. Follow-ups were performed at four, 12, 24 and 48 months postoperatively. Assessments included HRQoL (EQ-5D index score), hip function (Harris hip score [HHS]) and radiological acetabular erosion.

Results

The mean EQ-5D index score was generally higher among the patients with bipolar hemiarthroplasties at the follow-ups with a significant difference at 48 months: unipolar HAs 0.59 and bipolar HAs 0.70 (p = 0.04). There was an increased rate of acetabular erosion among the patients with unipolar hemiarthroplasties at the early follow-ups with a significant difference at 12 months (unipolar HAs 20 % and bipolar HAs 5 %, p = 0.03). At the later follow-ups the incidence of acetabular erosion accelerated in the bipolar group, and there were no significant differences between the groups at the 24- and 48-month follow-ups. There was no difference in HHS or reoperation rate between the groups at any of the follow-ups.

Conclusion

The bipolar HAs seem to result in better HRQoL beyond the first two years after surgery compared to unipolar HAs. Bipolar HAs displayed a later onset of acetabular erosion compared to unipolar HAs.     

空心螺钉捆绑带结合半髋关节置换治疗高龄粗隆间骨折的近期疗效

目的探讨空心螺钉捆绑带结合半髋关节置换治疗高龄股骨转子间骨折的近期疗效。 方法回顾性分析2015年8月至2017年8月新疆自治区人民医院收治的采用后外侧手术入路,股骨双动头置换结合空心螺钉及捆绑带重建股骨大粗隆的方法,治疗股骨粗隆间骨折尤其是股骨外侧壁破坏较为严重的高龄患者。术后第1天、第1、3、6个月及1年复查C反应蛋白、红细胞沉降率、血常规以及X线片,观察术后X线片是否达到骨性愈合,捆绑带及空心螺钉是否松动,股骨柄假体有无松动及下沉,使用Harris髋关节评分（HHS）评价患者髋关节功能,利用直立行走试验（TUG）评估关节活动。 结果15例患者术后1年的X线片均可见大转子骨折实现了骨性愈合,空心螺钉及捆绑带未见松动,骨水泥长柄稳定,未见明显松动及下沉,C反应蛋白、红细胞沉降率、血常规均正常,伤口局部无红肿,无感染征象。Harris评分：末次随访的HHS评分为（76±17）分。末次随访TUG为（17±9）s。术后2例患者出现大粗隆外侧活动后出现轻度疼痛,休息可缓解。末次随访,臀中肌外展肌力达到5级的共5例,4级共4例,3级的共3例。残留轻度跛行的3例,均为臀中肌外展肌力3级（2例）者。1例对手术疗效较不满意,跛行（1例）,其余14例表示非常满意或比较满意。所有患者均于术后3 d内下地行走。 结论采用股骨双动头置换,结合空心螺钉及捆绑带重建股骨大粗隆的方法,治疗高龄股骨转子间骨折,可获得早期初始稳定性,帮助患者早日下床活动,近期疗效较好,显著提高了患者的生活质量。     

Allometric scaling and biomechanical behavior of the bone tissue: an experimental intraspecific investigation

INTRODUCTION: Adaptation of bone to different loads has received much attention. This paper examines the consequences of differences in size on bones from the same animal species. METHODS: The study was conducted on 32 canine radii. Their geometry, densitometry and mechanical properties were determined and one-way ANOVA was used to analyze their distribution by sex. Bending failure was observed during the mechanical test. The bones were then likened to thin beams and the mechanical parameters of interest were appraised via beam theory. A multiple linear regression model with stepwise analyses was employed to determine which parameters rule the mechanical characteristics. The relationships between the bone mass and the parameters investigated were analyzed by means of a model II regression in order to state how the scaling of the bone characteristics act on its mechanical behavior. RESULTS: The linear regression model demonstrated that an animal's mass, its sex and the mineral content and the geometrical properties of its bones almost entirely predict their mechanical behavior. A close fit was found between the experimentally determined and the theoretical slopes of the log regressed allometric equations. The work to failure was found to scale almost linearly with the animal and bone mass and the macroscopical bone material properties were found to be mass invariant. The allometric equations showed that as the animal mass increases, employing proportionally the same amount of tissue, bones get proportionally shorter and proportionally distribute their tissue further from the cross-sectional centroid. CONCLUSIONS: Our results suggest that dimensional analysis on the assumption of geometrical self-similarity and mechanical testing according to classic elastic solutions are reasonable in bones tested in accordance to our set up. The bone geometry is the parameter able to curb the energy effects of an animal mass increase. The allometric scaling of the bone length and the cross-sectional layout, without an increase in the amount of material proportionally employed, preserves linear with the animal mass the amount of energy necessary to fracture a bone and restrain the rise of stresses and strains in the cross-section.     

Blood flow evaluation of vascularized bone transfers in a canine model

Blood flow in vascularized bone transfers was evaluated in a canine model. Cortical bone blood flow was determined in undisturbed control bone, vascularized heterotopic bone transfers, and nonvascularized cortical bone grafts by means of the radionuclide-labeled microsphere technique. Four animals were studied at 2 days, three at 1 week, eight at 2 weeks, four at 4 weeks, and three at 6 weeks postoperatively. In the 2-day animals, the vascularized bone transfers exhibited intermediate levels of blood flow (1.4 ± 0.4 ml/100 g of bone/min) compared with undisturbed control bone (2.7 ± 0.5 ml/100 g of bone/min) and conventional cortical bone grafts (0.0 ± 0.0 ml/100 g of bone/min). At 1 week postoperatively, the differences in blood flow values of the vascularized transfers (1.7 ± 0.7 ml/100 g of bone/min) and control bone (1.4 ± 1.0 ml/100 g of bone/min) and of the nonvascularized grafts (0.2 ± 0.1 ml/100 g of bone/min) and control bone (1.6 ± 1.1 ml/100 g of bone/min) were no longer significant. At 2 weeks postoperatively, blood flow had increased in both graft groups. At 4 weeks postoperatively, the bone blood flow values in the vascularized transfers (4.8 ± 1.4 ml/100 g of bone/min) were significantly greater than the bone blood flow in control specimens (1.6 ± 0.5 ml/100 g of bone/min) and conventional cortical bone grafts (2.5 ± 2.0 ml/100 g of bone/min). At 6 weeks postoperatively, the bone blood flow values in the vascularized transfers (4.0 ± 2.1 ml/100 g of bone/min) remained greater than the bone blood flow in control specimens (1.7 ± 0.5 ml/100 g of bone/min) and conventional cortical bone grafts (2.5 ± 2.7 ml/100 g of bone/min), but the differences were no longer significant.     

Reverse shoulder arthroplasty with metallic augments to preserve bone and restore joint line in patients with glenoid bone loss

BackgroundGlenoid bone loss poses significant challenges for reverse shoulder arthroplasty. In these patients, excess reaming can lead to further bone loss and medialization of the joint line. Metallic augments have been described as a technique for addressing this issue. However, there are currently no studies evaluating the effect of metallic augments on anatomic outcomes. This study evaluates the effect of metallic augments on the glenohumeral joint line and bone preservation. We hypothesize that metallic augments can preserve bone while preventing further medialization of the joint line in patients with preoperative glenoid bone loss.MethodsA prospective single-center, 2-surgeon consecutive case series was evaluated with postoperative computed tomography scans. Three-dimensional reconstruction was used to create models of the scapula and humerus. Comparisons were made with preoperative computed tomography scans using volumetric analysis to evaluate bone loss. The base of the coracoid was used as a constant landmark to assess the joint line position and, by proxy, the center of rotation. Further evaluation of the glenoid version and inclination was measured on the reconstructed models through standardized techniques.ResultsFifteen patients (16 implants) underwent preoperative planning and reverse shoulder arthroplasty with metallic augments from January 1, 2018, to January 1, 2021. The mean follow-up time was 13.1 months. Analysis revealed that augments prevented further medialization of the joint line and corrected the deficit on average by 10.2 mm (range 6.9-14.3; standard deviation 2.0). The mean bone volume removed during surgery was 1292 mm³ (range 525-2256; standard deviation 527), with this value inclusive of the baseplate post volume (～800 mm³). Inclination and version were restored to acceptable limits in all cases.ConclusionsReverse shoulder arthroplasty with metallic augments reliably preserves bone and prevents medialization of the joint line in patients with preoperative glenoid bone loss. Further research is required to assess the long-term and functional outcomes of this technique.     

Effect of hip hemiarthroplasty on articular cartilage and bone in a canine model

The purpose of this study was to determine if acetabular articular cartilage damage occurs in the presence or absence of changes in subchondral plate thickness or porosity and trabecular bone architecture after hip hemiarthroplasty. Eight canines were sacrificed 6 months after receiving unilateral hemiarthroplasties in which a cobalt chrome alloy femoral head was used. The acetabular cartilage, subchondral plate, and trabecular bone were quantitatively evaluated. Although the articular cartilage in the treated hip showed gross and histologic degenerative changes, there were no differences in the treated and contralateral hips in any of the trabecular bone parameters or subchondral plate thickness. However, the subchondral plate porosity was increased 2.6-fold in the treated hip. Therefore, degradation of cartilage can occur in the absence of thickening of the subchondral plate or alterations in the supporting trabecular bone architecture. These observations provide a better understanding of the role that periarticular bone has in the degenerative process after hemiarthoplasty.     

半髋柄固定方式对高龄股骨颈骨折疗效的影响

目的探讨半髋置换股骨柄在股骨近端髓腔不同形态固定方式对高龄股骨颈骨折疗效的影响。 方法回顾分析2007年1月至2017年2月在东莞市人民医院关节外科分别连续收治的75岁以上高龄股骨颈骨折患者100例,纳入标准：Garden Ⅲ、Ⅳ型、骨折前尚能独立行走;排除标准：股骨颈病理性骨折、同侧髋骨关节炎、严重内科疾病不能耐受手术。分为骨水泥组和生物组。骨水泥组行骨水泥股骨柄双动头置换术,生物组行生物双动头置换术,对比骨水泥组与生物组术中并发症,术后假体周围骨折情况,股骨近端髓腔Noble分型,股骨假体的初始位置,假体松动情况及其末次随访时的髋关节功能Harris评分差异,计量资料对比采用t检验,计数资料比较采用卡方检验。 结果100例患者均获得随访平均(15 ± 3)个月。骨水泥组术中出现明显骨水泥反应2例,未出现死亡病例,术后有2例出现假体周围骨折(Vancouver分型VB2型和VC型)。生物组术中出现股骨距骨折6例(Vancouver分型VAL型),术后假体周围骨折2例(Vancouver分型均为B2型),术后3个月内出现髋关节后脱位1例。术后3个月内死亡2例,均为肾功能衰竭患者。股骨柄的位置安放在内或外翻位>3°为异常时,100例中仅生物组1例烟囱型髓腔出现内翻位置达4°,异常率仅为1%。骨水泥型股骨柄容易出现外翻位放置,生物型股骨柄容易出现内翻位放置。术后末次随访髋关节功能Harris评分骨水泥组和生物组优良率分别为89%和83%,两组差异无统计学意义(χ²＝0.44,P>0.05)。 结论生物无领矩形股骨柄(LCU股骨柄)与有领骨水泥股骨柄(Classic股骨柄)双动头置换治疗高龄股骨颈骨折患者在股骨近端不同类型的髓腔中均能获得良好的治疗效果。     

Implantation accuracy of custom-made glenoid implants for treating severe glenoid bone deficiencies with reverse shoulder arthroplasty

BackgroundCustom-made three dimensional–printed glenoid implants for reverse shoulder arthroplasty are a modern treatment option for severe glenoid bone deficiencies. The potential advantages of not only achieving primary stability but also being able to realize the preoperative plan in terms of implantation accuracy at the same time have not yet been sufficiently investigated. The purpose of this study was to quantify the implantation precision of custom-made glenoid implants.MethodsTwelve consecutive patients with severe glenoid bone defects were treated between May 2019 and August 2020 using a custom-made glenoid implant (ProMade) (LimaCorporate, San Daniele, Italy) with reverse shoulder arthroplasty at a single hospital. All patients were eligible for inclusion and could be enrolled in this institutional review board–approved study. The immediate postoperative computer tomography–evaluated position of the glenoid implant was compared with the preoperative computer-based plan, on which the manufacturing process was based. As a result of this comparison, deviation measurements in six degrees of freedom (inclination, version, mediolateral offset, anteroposterior offset, superoinferior offset, and roll rotation) emerged.ResultsThe absolute average (mean value ± standard deviation) implantation deviation related to the plan was 1.6° ± 5.4° for version, 1.9° ± 4.1° for inclination, 0.3 mm ± 3.3 mm for mediolateral offset, 0.1 mm ± 1.9 mm for anteroposterior offset, 0.0 mm ± 2.4 mm for superoinferior offset, and 1.0° ± 6.3° for roll rotation. The augment volume averaged 9.0 cm³ ± 2.6 cm³. All custom-made glenoid implants were implanted with a subjectively sufficient primary stability.ConclusionThis study gives an indication that custom-made three dimensional–printed glenoid implants can be implanted with statistically high accuracy. To evaluate the clinical benefit and radiographic stability, a longer follow-up investigation is needed.     

Osteochondritis dissecans of the glenoid cavity: a case report

Osteochondrosis dissecans (OCD) is a form of osteochondrosis limited to the articular epiphysis. The most commonly affected areas include, in decreasing order of frequency, the femoral condyles, talar dome and capitellum of the humerus. OCD rarely occurs in the shoulder joint, where it involves either the humeral head or the glenoid. The purpose of this report is to present a case with glenoid cavity osteochondritis dissecans and clinical and radiological outcome after arthroscopic debridement. The patient underwent arthroscopy to remove the loose body and to microfracture the cavity. The patient was followed-up for 4 years and she is pain-free with full range of motion and a stable shoulder joint.     

肱骨头内松质骨含量的评估及临床意义

目的 通过CT平扫研究不同年龄、性别的患者肱骨头内松质骨的百分含量及其分布情况,确定肱骨头松质骨含量较高且可靠的部位,为临床治疗肱骨近端骨折提供理论基础.方法 选取2008年6月至2010年4月在我院应用肱骨近端锁定接骨板治疗的36例肱骨近端骨折患者的双侧肱骨近端CT样本,男18例,女18例；年龄20～86岁,平均51.6岁.按不同年龄分为A(＜40岁)、B(40～60岁)、C(＞60岁)3组,术前采用GE 16排螺旋CT扫描仪对患者健侧及患侧肱骨头进行1.0mm薄层扫描,像素的CT值采用HU记录,采集影像数据后分别使用Xiphoid 1.3、Image J 1.4 g及Image-Pro Plus 6.0测量数据并对数据进行处理.结果 肱骨头骨皮质存在4个薄弱部位,肱骨头内松质骨主要集中于肱骨头中央,C组的松质骨平均百分含量明显低于A、B组,差异有统计学意义(P＜0.05),A组中男性患者和女性患者肱骨头松质骨百分密度比较差异有统计学意义(t=4.744,P=0.001).结论 肱骨头内松质骨含量与年龄和性别有关,主要集中在肱骨头的内侧中央,是固定肱骨头较可靠的部位.     

Managing glenoid bone loss in total shoulder arthroplasty: Role of augmented patient-specific implants

Total shoulder arthroplasty has been shown to generate good to excellent results for patients with osteoarthritis and a functioning rotator cuff. However, a major complication after primary total shoulder arthroplasty is loosening of the glenoid component, which has been shown to be commonly associated with glenoid retroversion. This article highlights the importance of correcting the glenoid version and reviews various techniques, such as eccentric reaming, posterior bone grafting, reverse shoulder arthroplasty, and augmented glenoid implantation to address glenoid retroversion in the setting of total shoulder arthroplasty.     

Treatment of missed posterior dislocation of the shoulder by delayed open reduction and glenoid reconstruction with corticocancellous iliac bone autograft

This is a report of a 2-year follow-up of a missed posterior shoulder disclocation treated with open reduction and glenoid reconstruction with corticocancellous iliac bone autograft. In such cases, this treatment option may be an alternative to hemiarthroplasty of the shoulder.