The failure of a manipulative reduction of an anterior dislocation of the shoulder is rare. In elderly cases who demonstrate fragility caused by osteoporosis, the risk of a fracture increases during a reduction. We reported on a case of osteochondral fracture of the glenoid treated with an osteochondral graft. A 65-year-old woman dislocated her right shoulder when she fell forcefully. Initial radiographs showed an anterior dislocation without any fracture. A manipulative reduction by Hippocrates' maneuver was attempted, but concentric reduction could not be achieved. A second radiograph revealed a fragment on the posterior glenohumeral joint and a defect in the anterior glenoid rim. In operating findings, a cartilage defect was observed which covered 60% of the joint surface. The fragment was reduced anatomically, fixed with two absorbable pins and two cylindrical osteochondral grafts from the medial patellofemoral joint were transplanted to the glenoid cartilage surface using the press-fit technique to compress the floating edge of the fragment.20 months after surgery, the elevation was 140°, while the external rotation was 45° and the shoulder remains reduced and stable without pain. In this case, we chose an osteochondral plug, which utilizes a press fit technique. As a result, we were able to fix the large joint surface fragment firmly. The osteochondral graft procedure was described as an alternative method to fix the large joint surface fragment of the shoulder.
