Case: A 25-year-old male presented with a ballistic fracture of the right glenoid resulting in > 30% loss of the posterior glenoid articular surface and acute posterior glenohumeral instability that was treated with open reduction internal fixation with iliac crest autograft transfer.

Conclusion: There is limited consensus on the operative management of ballistic intra-articular fractures due to the heterogeneity of these injuries. Acute posterior glenohumeral instability secondary to a ballistic fracture is a rare injury pattern. In this case, we were able to successfully treat posterior glenohumeral instability with iliac crest autograft transfer and open reduction internal fixation.