JAAOS - 2026-03-03 - Journal Article
Management of Anterior Glenohumeral Dislocations in Elderly Patients.
Sheth M, Griffin D, Wiesel B, Nagda S
Topics
Key Takeaway
In elderly patients with anterior glenohumeral dislocation, glenoid fractures >25% of glenoid width with humeral subluxation warrant fixation, and reverse shoulder arthroplasty is the preferred salvage for recurrent instability with concurrent degenerative pathology.
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Summary
This narrative review addresses decision-making for anterior glenohumeral dislocations in elderly patients, a population with higher rates of rotator cuff tears, glenoid fractures, and peripheral nerve injury than younger cohorts. The authors synthesize management algorithms across four domains: conservative care, rotator cuff repair, capsulolabral reconstruction, and reverse shoulder arthroplasty. Key thresholds include glenoid fragment size >25% of glenoid width with subluxation as an indication for fixation, and RSA as the preferred construct when soft-tissue healing potential is compromised or preexisting degenerative changes are present.
Key Limitation
No patient-level outcome data are presented, so the recommended thresholds (e.g., 25% glenoid width) are expert-derived rather than evidence-validated in this population.
Original Abstract
The pathoanatomy of anterior glenohumeral dislocations in elderly patients is different from those in younger patients in that rotator cuff tears, large glenoid fractures, and peripheral nerve injury are more common. In addition, decision making is made more complex by the wide spectrum of preexisting degenerative pathology, functional demands, and social considerations, such as arthritis, chronic rotator cuff tears, and upper extremity demand for ambulation. Many patients with a first-time dislocation can be treated conservatively with a brief period of immobilization followed by physical rehabilitation. Rotator cuff repair is advisable for most active patients with symptomatic, acute tears. Capsulolabral repairs can be considered for similarly active patients with recurrent instability. Fixation of large glenoid fractures should be considered for patients with displaced fragments >25% of the glenoid width and/or demonstrating humeral subluxation through the fragment if there is adequate bone quality and healing potential. Reverse shoulder arthroplasty plays a large role in managing recurrent instability in patients with limited potential for soft-tissue or bone healing, inability to comply with soft-tissue repair postoperative protocols, and preexisting degenerative changes.