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

Background: 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. Methods: 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. Results: 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. Conclusion: 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.