Introduction: Neglected shoulder dislocations, defined as the loss of the glenohumeral joint relationship for more than three weeks without treatment, can lead to complex lesions, such as Hill-Sachs and Bankart fractures. Surgical management in elderly patients is challenging due to bone loss and soft tissue contractures. Case Presentation: We present the case of a 74-year-old male with a four-month history of a neglected anterior shoulder dislocation, a Hill-Sachs lesion, and a Bankart lesion. The patient underwent reverse total shoulder arthroplasty (RSA) with glenoid reconstruction using an autologous humeral head bone graft. The postoperative course was complicated by a retained intraoperative screwdriver tip fragment. At the 40-day follow-up, the patient reported no pain and showed improved functional scores (ASES 73, UCLA 21) despite the lack of formal physical therapy. Conclusion: RSA with bone grafting can provide satisfactory initial pain relief and functional improvement in complex chronic dislocations. However, this report highlights the critical need for longer-term follow-up to assess graft union and the potential implications of the retained intraoperative foreign body.
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