Isolated Large Glenoid Fracture in Acute Glenohumeral Dislocation in the Elderly: A Novel Indication for Reverse Shoulder Arthroplasty

Tyler Smith,Alfonso Arevalo,Joseph D’Alonzo,Jack Kazanjian

doi:10.1155/2020/8826803

Tyler Smith, Alfonso Arevalo + Show 2 more

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https://doi.org/10.1155/2020/8826803

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Abstract

Case Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA). Conclusion RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with open reduction internal fixation or potentially undergo revision operations.

Highlights

Bony Bankart fractures are a well-known complication of traumatic, anterior glenohumeral dislocation with an incidence ranging from 5.4 to 44% [1,2,3,4,5]
We present two cases of acute, traumatic shoulder dislocation associated with large anteroinferior glenoid fractures treated with reverse shoulder arthroplasty (RSA)
Itoi et al demonstrated in a biomechanical study that fractures involving greater than 21% of the glenoid width are at high risk for recurrent instability even after repair [13]

Summary

Introduction

Bony Bankart fractures are a well-known complication of traumatic, anterior glenohumeral dislocation with an incidence ranging from 5.4 to 44% [1,2,3,4,5]. The gold standard treatment for these large fractures has traditionally been open reduction and internal fixation (ORIF); implant complications, recurrent instability, and revision surgery are all concerns [8, 10, 16,17,18]. Treating these injuries in the elderly patient is especially complicated given the high incidence of osteoporosis, rotator cuff atrophy, and rotator cuff injuries at the time of dislocation [7, 19,20,21,22]. All patients provided informed consent for inclusion in the manuscript

Case 1

Case 2

Results

Discussion