2023 Specialty Day Access Pass-Critical Bone Loss: Which Bone Block Should I Choose?

Video Transcription

Video Summary

This panel discussion focuses on managing complex cases of shoulder instability with critical bone loss. It begins with a 17-year-old hockey player experiencing multiple dislocations after prior surgery. The experts debate treatment options including bone grafting and the Latarjet procedure, highlighting concerns about healing potential and choosing between arthroscopic and open techniques. They emphasize the importance of augmenting repairs with procedures like remplissage to address Hill-Sachs lesions and prevent recurrence. Next, they discuss a 31-year-old woman with recurrent instability after multiple failed surgeries, opting for revision distal tibial allograft (DTA) with remplissage despite challenges like screw removal and hyperlaxity. Finally, a severe case involves a 25-year-old seizure patient with massive bone loss and unstable fixation; the surgeons tailor the approach to avoid screw fixation due to seizure risk and prioritize stability. Throughout, the panel stresses individualized plans, careful imaging, and awareness of failure risks to optimize outcomes in shoulder instability with bone loss.

Asset Caption

John M. Tokish, M.D., FAANA

Keywords

shoulder instability

bone loss

Latarjet procedure

remplissage

revision distal tibial allograft