Arthroscopy-Assisted Reduction and Internal Fixation versus Open Reduction and Internal Fixation for Glenoid Fracture with Scapular Involvement: A Retrospective Cohort Study.

I-Hao Lin,Chia-Yu Lin,Chien-Sheng Lo,Hao-Wei Chang,Chin-Jung Hsu,Yi-Wen Chen,Tsung-Li Lin,Chun-Hao Tsai,Hui-Yi Chen

doi:10.3390/jcm11041131

Abstract

Background: We investigated the superiority of arthroscopy-assisted reduction and internal fixation (ARIF) to open reduction and internal fixation (ORIF) for treating glenoid fracture with scapular involvement. Methods: We retrospectively enrolled patients with glenoid fracture who underwent ARIF or ORIF from 2010–2020. Radiographic outcomes were assessed, and clinical outcomes (active range of motion [ROM], visual analog scale [VAS], Constant, and Disabilities of the Arm, Shoulder and Hand [DASH]) were evaluated 12 months postoperatively. Results: Forty-four patients with Ideberg type II–VI glenoid fractures (ARIF: 20; ORIF: 24; follow-up 12–22 months) were included. Union was achieved in all patients. Active ROM values were comparable between the approaches. Constant and DASH scores were non-significantly better with ARIF (90.9 ± 9.2 vs. 86.6 ± 18.1 [p = 0.341] and 6.8 ± 9.4 vs. 9.3 ± 21.3 [p = 0.626], respectively). However, VAS scores were significantly lower with ARIF (1.5 ± 0.6 vs. 2.7 ± 1.4, p = 0.001). Associated intra-articular lesions (articular depressions [80%], superior labral anterior-posterior tear [20%], labral tears [30%]) were found in most ARIF cases and were repaired during ARIF. Conclusions: For glenoid fracture with scapular involvement, ARIF allows accurate diagnosis of fracture pattern and the management of associated intra-articular lesions, with better pain control outcomes than ORIF. Thus, arthroscopy-assistant surgery should be considered in patient with glenoid fracture.

Highlights

Glenoid fracture with scapular involvement is a rare but challenging clinical problem [1]
Ideberg et al classified glenoid fractures into six types based on plain radiology films: type I glenoid fracture is glenoid fracture without scapular involvement and types II to VI
There are controversies regarding the treatment of glenoid fractures, which depend on the degree of displacement, the fracture gap, and the fragment size [5]

Summary

Introduction

Glenoid fracture with scapular involvement is a rare but challenging clinical problem [1]. Glenoid fractures are fractures with scapular involvement, with increasing complexity from type II to VI [2]. Most glenoid fractures were the result of high-energy injuries and were often associated with other injuries, including Hill-Sachs lesions and clavicular or acromial fracture, which require surgical management [6,7]. We investigated the superiority of arthroscopy-assisted reduction and internal fixation (ARIF) to open reduction and internal fixation (ORIF) for treating glenoid fracture with scapular involvement. Methods: We retrospectively enrolled patients with glenoid fracture who underwent ARIF or ORIF from 2010–2020. Results: Forty-four patients with Ideberg type II–VI glenoid fractures (ARIF: 20; ORIF: 24; follow-up 12–22 months) were included. Conclusions: For glenoid fracture with scapular involvement, ARIF allows accurate diagnosis of fracture pattern and the management of associated intra-articular lesions, with better pain control outcomes than ORIF. Arthroscopy-assistant surgery should be considered in patient with glenoid fracture

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