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Background: Posttraumatic shoulder dislocations with glenoid rim fractures show high rates of dislocation recurrence. For glenoid rim defects exceeding a certain size, several investigators recommend bone grafting. Few reports on anatomical glenoid reconstruction addressing this problem are published.

Hypothesis: Anatomical glenoid reconstruction by the J-bone graft creates permanent joint stability without a clinically relevant loss of motion.

Study Design: Case series; Level of evidence, 4.

Methods: Forty-seven shoulders with glenoid rim fractures after recurrent anterior dislocation were stabilized by a J-bone graft. For clinical outcome, motion and strength compared with the uninjured shoulder, as well as sports activity, were recorded. The Rowe score and the Constant-Murley score were used for scoring. In cases of follow-up exceeding 6 years, computed tomography scans were obtained and compared to preoperative radiographs.

Results: The mean Rowe score was 94.3 for the affected shoulder and 96.8 for the uninjured side. The Constant score reached 93.5 and 95 points, respectively. Loss of external rotation was 4.36° in adduction and 3.19° at 90° of abduction. The computed tomography evaluation included 24 shoulders at a mean follow-up of 106.2 months. There were no recurrences of instability and 1 traumatic graft fracture. Of the 19 patients in whom arthropathy was present at follow-up, 11 had arthrosis before surgery.

Conclusion: The J-bone graft is capable of creating a stable shoulder joint without causing extensive loss of motion on the long term in patients with traumatic glenoid rim fractures after shoulder dislocation. In some patients, mild to moderate arthropathy develops despite anatomical glenoid reconstruction.

Background: Neglected unreduced posterior shoulder dislocation is a challenging orthopaedic problem.

Purpose: To evaluate the results of open reduction with posterior cruciate capsular repair for such cases. This corrects the wide posterior capsule, which is the main pathologic entity.

Study Design: Case series; Level of evidence, 4.

Methods: Over a period of 5 years, 17 patients with unreduced neglected posterior shoulder dislocation with an impression fracture involving less than 25% of the humeral head were treated by open reduction together with posterior cruciate capsular repair as described by Neer. The patients’ average age was 48.5 years (range, 32.5–66 years). There were 14 men and 3 women. The dominant shoulder was affected in 14 cases.

Results: After a minimum follow-up of 5 years (range, 5–10 years), the average UCLA score improved from 18 preoperatively to 33 postoperatively. The average modified Rowe score changed from 42.2 to 78.4 points. The American Shoulder and Elbow Surgeons Shoulder score showed an average of 40.3 points preoperatively and an average of 79.8 points at final follow-up. Three patients developed late osteoarthritic changes. Two had changes of mild degree, and 1 needed a total shoulder replacement.

Conclusion: Open reduction with posterior cruciate capsular repair offers a good solution for the problem of neglected unreduced posterior shoulder dislocation excluding cases with osteoarthritic changes and those with impression fracture involving less than 25% of the head.