{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:11:29Z","timestamp":1779880289281,"version":"3.53.1"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Massive proximal humeral bone loss with concomitant rotator cuff deficiency is a rare and complex reconstructive challenge, particularly after high-energy trauma. Reverse shoulder arthroplasty (RSA) with an allograft\u2013prosthesis composite (APC) restores humeral length and soft-tissue attachment, while tendon transfer addresses residual rotational deficits. We report a 35-year-old male who presented two weeks after a gunshot injury with an 8-cm open wound and extensive proximal humeral bone loss. Following serial debridement and culture-directed antibiotics, staged reconstruction was undertaken. Initial stabilization with intramedullary nailing and a cement spacer was followed by definitive RSA-APC 21\u00a0months post-injury. A structural proximal humeral allograft was fixed with an anterolateral plate, and a lower trapezius tendon transfer was performed using the allograft\u2019s native soft-tissue attachment as a biologic anchor. At 2-year follow-up, complete graft incorporation was observed with meaningful functional improvement.<\/jats:p>","DOI":"10.1093\/jscr\/rjag384","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:35:09Z","timestamp":1779190509000},"source":"Crossref","is-referenced-by-count":0,"title":["Staged reverse shoulder arthroplasty with structural allograft\u2013prosthesis composite and lower trapezius tendon transfer for massive proximal humeral bone loss following gunshot injury: a case report"],"prefix":"10.1093","volume":"2026","author":[{"given":"Ibrahim","family":"Ababtain","sequence":"first","affiliation":[{"name":"Orthopedic Department, Prince Sultan Military Medical City , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4861-733X","authenticated-orcid":false,"given":"Abdulaziz S","family":"AlNahari","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sultan","family":"Alsuhaim","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Prince Sultan Military Medical City , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasser S","family":"Alsaleh","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Prince Sultan Military Medical City , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamad H","family":"Aldakhil Allah","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Prince Sultan Military Medical City , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan Abdullah","family":"AlRamadhan","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Prince Sultan Military Medical City , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"2026052706571770800_ref1","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1302\/2046-3758.122.bjr-2022-0275.r1","article-title":"Proximal humerus fractures \u2013 epidemiology, comparison of mortality rates after surgical versus non-surgical treatment, and analysis of risk factors based on Medicare registry data","volume":"12","author":"Walter","year":"2023","journal-title":"Bone Joint Res"},{"key":"2026052706571770800_ref2","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1186\/s13018-021-02551-x","article-title":"Epidemiology of proximal humerus fractures","volume":"16","author":"Iglesias-Rodr\u00edguez","year":"2021","journal-title":"J Orthopaedic Surg Res"},{"key":"2026052706571770800_ref3","doi-asserted-by":"publisher","DOI":"10.1097\/oi9.0000000000000382","article-title":"Proximal humerus fractures: treatment controversies","volume":"8","author":"Kandemir","year":"2025","journal-title":"OTA Int"},{"key":"2026052706571770800_ref4","doi-asserted-by":"publisher","first-page":"30","DOI":"10.21037\/aoj-24-70","article-title":"Management of proximal humeral bone loss: a narrative review","volume":"10","author":"Grobaty","year":"2023","journal-title":"Ann Joint"},{"key":"2026052706571770800_ref5","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.xrrt.2024.12.001","article-title":"Reverse shoulder-allograft prosthetic composite reconstruction for a failed reverse Total shoulder arthroplasty with massive proximal humeral bone loss and a fractured modular humeral stem: a case report","volume":"5","author":"Melton","year":"2025","journal-title":"JSES Reviews Reports and Techniques"},{"key":"2026052706571770800_ref6","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s10195-024-00784-0","article-title":"Revision shoulder arthroplasty and proximal humeral bone loss: a comprehensive review and proposal of a new algorithm of management","volume":"25","author":"Baldari","year":"2024","journal-title":"J Orthop Traumatol"},{"key":"2026052706571770800_ref7","doi-asserted-by":"publisher","DOI":"10.52965\/001c.138668","article-title":"Evaluating the efficacy of trapezius transfer in the management of massive rotator cuff tears: a systematic review of clinical outcomes","volume":"17","author":"Velichala","year":"2025","journal-title":"Orthop Rev"},{"key":"2026052706571770800_ref8","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.18203\/2349-2902.isj20243555","article-title":"Reverse total shoulder arthroplasty with allograft bone block augmentation following proximal humerus sarcoma resection: a novel technique and case report of two patients","volume":"11","author":"Hammad","year":"2024","journal-title":"Int Surg J"},{"key":"2026052706571770800_ref9","doi-asserted-by":"publisher","first-page":"e1043","DOI":"10.1016\/j.jse.2025.02.029","article-title":"Lower trapezius tendon transfer versus reverse shoulder arthroplasty for massive irreparable rotator cuff tears: an in-vivo scapulohumeral rhythm dynamic radiography study","volume":"34","author":"Hussain","year":"2025","journal-title":"J Shoulder Elbow Surg"},{"key":"2026052706571770800_ref10","doi-asserted-by":"publisher","first-page":"202","DOI":"10.5397\/cise.2021.00745","article-title":"Short-term outcomes of two-stage reverse total shoulder arthroplasty with antibiotic-loaded cement spacer for shoulder infection","volume":"25","author":"Kim","year":"2022","journal-title":"Clin Shoulder Elbow"},{"key":"2026052706571770800_ref11","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1007\/s11999.0000000000000049","article-title":"Staged revision with antibiotic spacers for shoulder prosthetic joint infections yields high infection control","volume":"476","author":"Grubhofer","year":"2018","journal-title":"Clin Orthop Relat Res"},{"key":"2026052706571770800_ref12","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.jor.2020.08.007","article-title":"Techniques for lower trapezius tendon transfer for the management of irreparable posterosuperior rotator cuff tears","volume":"22","author":"Ghoraishian","year":"2020","journal-title":"J Orthop"}],"container-title":["Journal of Surgical Case 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