Combined fractures of the humeral head and the glenoid

Abstract

Glenohumeral combination fractures are severe shoulder injuries for which, however, few data are available in the literature. The aim of the study was to analyze the incidence and numeric distribution of glenohumeral combination fractures using a classification system. Furthermore, treatment methods and complications are discussed. This retrospective study is based on the data evaluation of a level I trauma center between 1998 and 2016. Glenohumeral combination fractures are classified into four types, and the incidence, treatment method, and complications are evaluated. Additionally, the fracture morphology and displacement of the different fracture types are analyzed. In total, 52 patients with a glenohumeral combination fracture were identified. There were 26 (50%) type 1 fractures (anterior glenoid rim fracture/greater tuberosity fracture), 20 (38%) type 2 fractures (anterior glenoid rim fractures and proximal humerus fractures), four (8%) type 3 fractures (glenoid fossa fractures and greater tuberosity fractures), and two (4%) type 4 fractures (glenoid fossa fractures and proximal humerus fractures). In the majority of patients (n = 25), both lesions of the combined fractures were treated operatively, in 15 both fractures were treated nonoperatively, and in 12 patients only one of the two lesions was treated surgically. Complications were encountered in 21% of cases, particularly on the humeral side. Glenohumeral combination fractures are rare. Type 1 and type 2 fractures are the most frequent combination fractures. The indications for treatment are based on the displacement of the respective fragments, which can be addressed during the same operation if surgery is indicated. Complications are more frequently found on the humeral side.