# A Case Report of Iliac Punch-Out Grafting: A Novel Surgical Technique for Angled Bony Increased Offset Reverse Shoulder Arthroplasty

## TL;DR

A new surgical technique called iliac punch-out grafting is introduced to avoid donor-site complications in shoulder reconstruction.

## Contribution

The novel iliac punch-out grafting technique preserves the iliac crest while enabling bone harvesting for shoulder arthroplasty.

## Key findings

- The technique allowed successful bone grafting without donor-site complications.
- The patient experienced favorable clinical outcomes post-surgery.
- This method may be a viable option for structural reconstruction in reverse shoulder arthroplasty.

## Abstract

Conventional iliac crest bone grafting is often used in shoulder reconstruction; however, it may lead to donor-site complications. To address this concern, we applied a novel punch-out technique that enables cylindrical bone harvesting from the iliac wing while preserving the iliac crest. A 61-year-old woman with long-standing rheumatoid arthritis presented with right shoulder pain and functional impairment. Imaging revealed severe glenoid bone loss with insufficient humeral bone stock for standard reconstruction. She underwent a bony increased offset reverse shoulder arthroplasty using iliac punch-out grafting. The procedure was completed without complications, and the postoperative course was favorable. This technique enabled bone grafting without compromising the iliac crest. In this case, no donor-site complications were observed, and the clinical outcome was favorable. Iliac punch-out grafting may therefore be considered a potential option for structural reconstruction in reverse shoulder arthroplasty, although further investigation is warranted.