Management of anterior instability of the shoulder with bone defects

192 ABSTRACT Objective: A review is made to summarize the most relevant information on shoulder instability with bone defects and to serve as a guide for the study of this type of disorder and its management. Method: A literature review was carried out. Results and conclusions: The study of instability with bone defects requires correct clinical and radiological detection. Computed tomography with three-dimensional reconstruction can offer an objective preoperative analysis of the location and degree of the defect, and diagnostic arthroscopy plays an important role in deciding treatment. The definition of bone defects of the glenoid cavity, humeral defects and combined bone defects, together with the glenoid track concept, are fundamental for a correct understanding of the risk of relapse and the relative glenohumeral position in which the latter occurs thus warranting the use of bone block techniques associated to soft tissue repair. The critical percentage glenoid cavity defect justifying the need to apply these techniques is subject to debate. The Latarjet procedure and other bone block techniques are widely used to treat glenoid bone defects. In the case of humeral bone defects, remplissage is a widely used procedure, and may exert an influence upon the postoperative range of motion. Clinical relevance: The recommendations made in this article seek to serve as a support for study and decision making in the clinical practice of specialists that deal with disorders of this kind. RESUMEN Manejo de la inestabilidad anterior de hombro con defectos óseos