# Sandwich Reconstruction Technique for Severe Glenoid Bone Loss in Reverse Shoulder Arthroplasty Using Iliac Crest Autograft and Coracoid Transfer

## TL;DR

This paper introduces a new surgical technique for shoulder replacement in patients with severe bone loss, using two types of grafts to improve implant stability.

## Contribution

The novel 'sandwich' technique combines iliac crest and vascularized coracoid grafts with a wedge-augmented baseplate for enhanced stability in severe glenoid bone loss.

## Key findings

- The sandwich grafting technique restores native glenoid anatomy and improves implant stability.
- The method is suitable for severe glenoid bone loss classified as Walch B3, C, and D.
- Dual-graft approach overcomes limitations of single-graft techniques and augmented baseplates.

## Abstract

This Technical Note describes a sandwich grafting technique that combines a posterior tricortical iliac crest autograft with an anterior vascularized coracoid graft, secured with a full wedge-augmented baseplate. The method enhances fixation by leveraging the mechanical stability of the iliac crest graft, the biological integration of the vascularized coracoid, and the stability provided by the wedge-augmented baseplate. The screws are positioned in 2 axes to optimize stability and promote graft incorporation. This dual-graft approach addresses the limitations of single-graft techniques and augmented baseplates by restoring native glenoid anatomy and improving implant stability. The technique is particularly suited for cases with severe anterior-posterior or global glenoid bone loss, as classified by the Walch B3, C, and D categories.