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

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.