Glenoid Fractures Research Articles

A novel arthroscopic transosseous suture-button fixation technique for anterior glenoid fractures

Abstract Background This study evaluated the clinical and radiological results of a new transosseous suture-button fixation technique for anterior glenoid fractures. Methods From March 2017 to May 2021, 23 patients with anterior glenoid fractures were treated with the new technique. Demographic data, active shoulder function, and several shoulder scores were evaluated after a minimum of 6 months. Fracture reduction and button placement were assessed via computed tomography, while fracture healing and onset or progression of glenohumeral osteoarthritis were evaluated with X‑rays. Results Overall, 57% of the patients had relevant concomitant intra-articular injury. Clinical follow-up was performed for 22 patients (19 male, 3 female) at 15 months (6.0–34.5) after surgery. The average Constant Score was 83.2 ± 16.7 points (93.4% ± 18.8% vs. the contralateral side), the Rowe Score, 90.7 ± 10.4 points, the Melbourne Instability Shoulder Score (/100), 88.3 ± 14.5 points, the Western Ontario Shoulder Instability Index (%), 82.9 ± 16.7, and the Subjective Shoulder Value (%), 86.9 ± 16.1. Average range of motion was 171.4 ° ± 22.7 ° of flexion (contralateral side, 180 ° ± 0 °; p = 0.11) and 170.5 ° ± 23.6 ° of abduction (contralateral side, 179.6 ± 2.1; p = 0.07). No complications occurred and no revision surgery was required. The postoperative step-off of the glenoid averaged 1.55 ± 1.05 mm (0–4 mm). Radiological follow-up of 19 patients showed fracture consolidation in all cases, without secondary dislocation of the fracture or of heterotopic ossification. There was no sign hardware impingement or dislocation. There was new-onset osteoarthritis in 3 cases (15.8%). We found no correlation between the step-off and radiological signs of osteoarthritis. Conclusion Anterior glenoid fractures were treated safely and reproducibly with the novel arthroscopic double-button-suture technique, but long-term results are still needed.

Open reduction and internal fixation of Ideberg type IA glenoid fractures: Tricks, pearls, and potential pitfalls based on a retrospective cohort of 33 patients focusing on the rehabilitation protocol.

The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim is to describe the surgical steps for ORIF of anterior and anteroinferior glenoid rim fractures using the anterior axillary approach, describing the tricks, pearls, and pitfalls of this surgical technique. A retrospective cohort of skeletally mature patients treated for an anterior glenoid rim fracture carrying > 20% of the glenoid fossa during a 10-year period were operated on using a vertical axillary incision, osteosynthesis with 2.0-mm cortical screws, and labral repair with small diameter metallic anchors and non-absorbable sutures. Rehabilitation began on the first postoperative day, including passive external rotation exercises and active-assisted flexion, adduction, and abduction exercises as tolerated. The exercises are performed with the patient sitting or lying down. Phase 1 is continued for 6-10weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10weeks, the fracture and labrum are healed, so phase 2 rehabilitation begins with strengthening and ROM exercises. Radiologic and clinical outcomes, including active range of motion (ROM), glenohumeral stability, and visual analogue scale (VAS) were measured. About 33 patients (35 fractures) had complete medical records and pre- and post-operative imaging exams available for further analysis regarding the surgical protocol, with a mean of 4.8years. The mean DASH questionnaire was 3.75 ± 9.0 and the mean CM score was 62.5 ± 0.1. Active flexion and internal rotation were recovered in all patients, while external rotation presented an average loss of 8° (p = 0.12) and abduction of 5° (p = 0.33). The mean VAS was 1.1 ± 0.8. No patient reported major or disabling symptoms, or great difficulty or inability to perform daily or recreational activities. No patient presented residual instability of the glenohumeral joint. In this retrospective cohort, ORIF using a vertical axillary incision, osteosynthesis with 2.0-mm screws, and labral repair with small diameter metallic anchors and non-absorbable sutures was a safe approach, with a minimal risk of complications and residual instability. The accelerated postoperative rehabilitation protocol, allowing immediate passive external rotation of the operated shoulder, resulted in a non-significant loss of ROM compared to the contralateral side. Therefore, we recommend this management strategy for anterior glenoid rim fractures in patients with unstable shoulder joint after traumatic glenohumeral dislocation. Therapeutic Study (Surgical technique and Retrospective cohort).

Wrestler's Shoulder

History: 14 year old male with left shoulder pain after injury during wrestling meet. He was participating in wrestling meet 2 days prior when he was thrown to the mat. He landed on his left elbow and felt immediate pain in his shoulder, was unable to move the shoulder due to pain. He has decreased range of motion and weakness with shoulder movement, pain with moving, lifting, and sleeping. Denies any radiating pain, numbness/tingling or history of prior shoulder injuries. Physical Examination: No obvious deformity, no bony tenderness to palpation. Active ROM is forward flexion to 140 degrees with pain, abduction to 120 degrees with pain, external rotation with elbow at side to 20 degrees with pain, internal rotation to L3 with pain. Passive ROM full in all directions. The belly-press test, lift-off tests are abnormal, and the bear hug test shows weakness. Strength 4/5 of the infraspinatus, 4/5 of supraspinatus with pain. Neer/Hawkins, Obrien's signs negative. Neurovascularly intact in the bilateral upper extremities. Differential Diagnosis: Humeral, glenoid or scapular fracture, Rotator cuff tear, AC joint dislocation Final/Working Diagnosis: Fracture to base of coracoid process, Avulsion fracture of lesser tuberosity of humerus Tests and Results: Xray L shoulder: Humeral head high-riding. Widening of the left coracoid on axillary view. Widening of the AC joint. Humeral physes open, normal and symmetric compared to contralateral shoulder. MRI L shoulder: Minimally displaced fracture through base of the coracoid process, medially-displaced, lesser tuberosity physeal fracture. Hemarthrosis of the glenohumeral joint. Edema within subscapularis muscle belly. No rotator cuff full-thickness tears. Treatment and Outcomes: Athlete was referred to an Orthopaedic surgeon and underwent lesser tuberosity avulsion repair, coracoid ORIF, and closed treatment of AC joint instability. Patient immobilized in a sling for 6 weeks post-operatively. Passive ROM was initiated at 2 weeks post-operatively. Active ROM was allowed at 6 weeks progressing to full active elevation. Athlete was allowed to begin weight-lifting as tolerated, running and non-contact practice at 8 weeks. Post-operative course was uncomplicated and the athlete was cleared for full return at 12 weeks post-operatively.

Accuracy of MR arthrography in the detection of posterior glenoid labral injuries of the shoulder

ObjectiveThe purpose of this study is to evaluate the accuracy of MR arthrography in detecting isolated posterior glenoid labral injuries using arthroscopy as the reference standard.MethodsMR arthrograms of 97 patients with isolated posterior glenoid labral tears by arthroscopy and those of 96 age and gender-matched controls with intact posterior labra were reviewed by two blinded radiologists for the presence and location of posterior labral abnormalities. The sensitivity and specificity of detection of posterior labral tears were calculated as well as the prevalence of associated pathologies. Medical records were reviewed for demographics, history and direction of shoulder instability, and prior surgery.ResultsPosterior labral pathology was detected by MR arthrography with sensitivities of 76% and 84% for readers 1 and 2, and a specificity of 88% for both readers. Kappa value for interreader agreement was 0.91. Twenty-two of twenty-three (96%) tears isolated to the posteroinferior quadrant on arthroscopy were correctly identified on MRI. Commonly associated pathologies included paralabral cyst (38%), humeral fracture (7%), and glenoid fracture (2%). Fifteen of ninety-seven (16%) patients with posterior tears on both arthroscopy and MRI had glenoid rim deficiency on imaging versus no patients with intact posterior labra (p < 0.001). Forty of ninety-seven (41%) patients with posterior tears on arthroscopy had a history of posterior instability versus none without posterior tears. There was no significant difference in tear length on MRI between those with a history of instability and those without (p = 0.56).ConclusionMR arthrography is accurate in detecting posterior glenoid labroligamentous injuries.

Glenoid Morphology and Related Parameters in Turkish Society.

IntroductionGlenoid morphology may vary in different ethnic groups. Detection of these differences may be important in preoperative planning, especially in reverse shoulder arthroplasty. In this study, we investigated the mean glenoid size and retroversion in Turkish society and their relationship with the dominant side, gender, height, weight, and body mass index (BMI).Materials and methodsBetween 2019 and 2021, 102 shoulders of 51 patients (24 females/27 males, 51 left/51 right) who were included in shoulder joint imaging during thorax CT scanning were examined. Those with glenoid fracture, arthrosis, shoulder surgery or deformity, or younger than 18 years of age were not included in the study. The mean age was 41.69 (range: 18-73) years. Glenoid anterior-posterior diameter (D) and glenoid version (GV) were measured in axial slices, and glenoid height (H) was measured in coronal slices. The correlation of these parameters with gender, height, weight, and dominant side was examined.ResultsMean D was 25.79±4.44 mm, mean H was 29.08±4.08 mm, and mean GV was -0.99°±0.92°. The mean height of the patients was 162±16.23 cm and the mean weight was 71.9±15.36 kg. The glenoid diameter and height were smaller in females, however, no statistically significant difference was found in the glenoid version (p<0.01, p<0.01, and p=0.92). The glenoid on the dominant side was statistically significantly more retroverted, whereas D and H were not associated with dominance (p<0.01, p=0.9, and p=0.98). It was found that the glenoid sizes were very highly correlated with the patient's height, and it was highly correlated with the patient's weight (p<0.01 and p<0.01). On the other hand, height and weight were not correlated with the glenoid version (p=0.47 and p=0.81, respectively). There was no statistically significant relationship between BMI and glenoid sizes and glenoid version (p=0.14 and p=0.46, respectively).ConclusionsFemales in Turkish society had small glenoid sizes. Male gender, height, and weight were positively correlated with large glenoids. The glenoid was more retroverted on the dominant side. These findings should be considered in preoperative planning in Turkish society.

Han's technique: a new reduction technique for acute anterior shoulder dislocation.

Acute anterior shoulder dislocation (AASD) is the most common joint dislocation. Here, we introduced a new reduction technique for AASD, named "Han's technique" (or "Touch overhead technique"). Patients diagnosed with AASD were treated with "Han's technique" in the orthopaedic department of our hospital from October 2018 to November 2020. An orthopedic surgeon performed the reduction maneuver without any anesthesia or sedation throughout the reduction process. The fundamental information and related data were recorded, including patients' age, sex, dislocation side, previous dislocations history, reduction time, number of attempts at reduction, success rate of the reduction, intensity of pain during reduction using the 10-point visual analogue scale score (VAS), any complications, with or without the fracture and neurovascular examination results. Forty-one patients with AASD were involved in our study. Thirty-nine cases (95%) were primary dislocation. Eleven patients (27%) were complicated with large tubercle fracture and one patient (2%) complicated with inferior glenoid fractures. All patients were successfully reduced by Han's technique with mean reduction time was 138s. The pain score during the reduction operation is only1.83 ± 0.83 points. No neurovascular injury or iatrogenic fracture was found after reduction in all patients. Han's technique (or Touch overhead technique) is a simple, safe, effective, mild and easy to master which can be operated by one surgeon without anesthesia or sedation for AASD.

Management of amultifragmentary glenoid fracture : Case report of atwo-stage surgical procedure

This article describes amultifragmentary glenoid fracture in a65-year-old patient after falling from aheight of2m. The accident led to complete Y‑shaped destruction of the glenohumeral joint with alarge posteroinferior fragment and a large anteroinferior glenoid fragment. The treatment consisted of atwo-stage surgical procedure and acombination of open and arthroscopic techniques. First, open surgery of one fragment from the dorsal side was performed using screw osteosynthesis. Arthroscopic refixation of the anterior glenoid fragment (bony Bankart lesion) followed 4 weeks later using aguided Endobutton® technique (Smith & Nephew). Ideberg type6multifragmentary glenoid fractures are rare and should be treated surgically, especially with dislocated fragments, instability in the glenohumeral joint and in younger patients. Given the lack of evidence in the literature, individual surgical strategies are necessary.

A new surgical approach for the treatment of scapular glenoid fractures- Axillary approach: A single center case series

BackgroundThe purpose of this study was to assess the efficacy of the scapular glenoid fractures by a new surgical approach (Axillary approach) through follow-up studies. MethodWe retrospectively analyzed the prospectively collected data from 11cases of glenoid fractures were treated by open reduction and internal fixation through a Axillary approach approach between July 2019 and October 2020. All patients were required to conform to regular follow up postoperatively. X-ray film and CT scan was applied to all cases. The Constant score system, the UCLA score system and DASH score system were used to evaluate functional results. ResultsAll patients achieved bone union. At the final follow-up, the mean Constant score was 92.5 ± 3.0 (range 85–97) points and the mean UCLA score was 33.5 ± 1.6 (range 31–36) points. According to the UCLA score system, two patients achieved excellent results and one patients had good results. The mean DASH scores were 7.7 ± 3.2 (range 4–12). Compared with the preoperative functional score, it was significantly improved (P < 0.01). ConclusionsThe axillary approach as a new method for scapular glenoid fractures (especially the fracture of the lower half of the scapular glenoid) has achieved desired results, and it can provide new options for clinical treatment. Level of evidenceLevel III; Development or Validation of Outcome Instrument© 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Acromioclavicular dislocation associated with scapular fractures - pathoanatomy of the injury.

No detailed study dealing with an injury to the AC joint in combination with scapular fractures has been published to date. The aim of this study is to describe pathoanatomy of these injuries. In a series of 519 scapular fractures in adult patients from the period of 20022020 we identified a total of 20 (3.9%) cases associated with AC dislocation. The group comprised 17 men and 3 women with the mean age of 49 years (range, 2178). Radiographs of the shoulder joint followed by CT examination, including 3D reconstructions, were performed in all patients. This documentation allowed assessment of the scapular fracture pattern and type of injury to the AC joint. AC dislocation was associated with a simple scapular fracture in 15 cases (7 fractures of the coracoid base, 4 fractures of the acromion or the lateral spine, 2 fractures of the scapular body, 1 fracture of the superior and 1 fracture of the inferior glenoid). In 5 cases AC dislocation accompanied multiple or complex scapular fractures (once a combination of a coracoid fracture and a fracture of the lateral scapular spine, once a combination of a fracture of the superior glenoid and of the acromion, 2 cases of a complex intraarticular fracture and 1 case of scapulothoracic dissociation). AC dislocation is relatively infrequent injury accompanying scapular fractures. It is most commonly associated with fractures of coracoid, acromion/lateral spine or superior glenoid. No case of AC dislocation was recorded in a fracture of the scapular neck.

Modified Double-Row and Double-Pulley Technique for the Treatment of Type Ia Scapular Glenoid Fractures.

ObjectiveTo evaluate the efficacy of the double‐row and double‐pulley technique in treating anterior shoulder glenoid fracture (Ideberg type Ia) using shoulder arthroscopy.MethodsThirty‐six patients with Ideberg type Ia admitted from March 1, 2017, to March 1, 2020, were retrospectively reviewed. Data of the patients' history included age, sex, side of the affected arm, the mean time from injury to surgery, the surgical duration, the average blood loss, and the average total duration of hospital stay. The double‐row and double‐pulley technique was used to repair the scapular glenoid fracture under arthroscopy. Computed tomography (CT) was used to evaluate fracture healing after surgery. The American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder joint scoring system, and the Constant–Murley shoulder function score were used to assess the function of the affected shoulder.ResultsThe surgical duration was 90–150 min, with a mean of 127 min. The average blood loss was 90 mL (range, 60–120 mL), and the average total duration of hospital stay was 9.2 days (range, 3 to 14 days). At 9 months after surgery, the CT results showed that all fractures healed, and all patients returned to their previous levels of activity and regained an excellent range of motion. The visual analog scale (VAS) score was 7.55 ± 1.32 before surgery, and the VAS score significantly decreased to 1.24 ± 0.72 at 12 months after the operation (p < 0.05). The Constant, ASES, and UCLA shoulder function scores were 44.38 ± 2.16, 43.47 ± 12.76, and 21.80 ± 1.16 before the surgery, respectively, which improved to 93.52 ± 2.82, 91.34 ± 8.28, and 33.24 ± 1.64, respectively, in the following 12 months. One patient experienced fat liquefaction. However, no cases of deep venous thrombosis, iatrogenic neurovascular compromise, wound infection, or neurovascular injury were identified.ConclusionThe double‐row and double‐pulley technique for treating Ideberg type Ia under shoulder arthroscopy has minor surgical trauma, reliable fracture reduction and fixation, less postoperative pain, and fewer postoperative complications and significantly improves the patient's shoulder joint function.

Comparison of a Novel MRI Technique that Produces Equivalent Bone Contrast with 2D-CT for the Assessment of Glenoid Bone Loss

Background:Advanced imaging in patients with shoulder instability can be variable. MRI offers visualization of soft tissue injuries including capsulolabral injuries, however may not be ideal to assess osseous injuries. CT examination may often be desired as the accepted standard for assessment of glenoid and humeral bone loss, the extent of which can dictate surgical management in the adolescent age group in which bone loss is common.Hypothesis/Purpose:Our hypothesis, MRI bone sequence/method (FRACTURE: FFE Resembling A CT Using Restricted Echo-spacing) can provide measurements comparable to standard CT for glenoid bone loss. The objective of this study was to validate this technique in a cadaveric glenoid bone loss model using 2D-CT as the reference standard.Methods:Glenoid fractures of varying sizes were arthroscopically created in 10 cadaveric shoulders. 2D-CT and MRI FRACTURE on 3T Philips Ingenia; Philips Healthcare, Best, Netherlands) were performed on all 10 shoulders. FRACTURE is a 3D-gradient echo pulse sequence with restricted echo-spacing combined with an automated post-processing is a technical innovation which provides superior cortical and trabecular bone contrast on MRI. The CT and MRI were presented in a blinded fashion to 2 experienced musculoskeletal radiologists for independent measurement of the glenoid fracture length, width, as well as % glenoid bone loss using the best-fit circle method. Paired t-tests were performed to compare the measurements obtained on CT with those obtained on the MR FRACTURE images. Intraclass correlation coefficient was used to measure interobserver reliability.Results:There was no statistically significant difference between CT and MRI in terms of the measured glenoid fracture length(P-value=0.54) or fracture width(P-value=0.86). The mean length measured on CT was 23.40 mm ± 6.87 and on MRI was 22.96 mm ± 7.38. The mean width on CT measured 7.96 mm ± 3.51 and on MRI measured 7.89 mm ± 3.18. There was also no statistically significant difference between CT and MRI in terms of measured glenoid bone loss (P-value=0.65). Intraclass correlation coefficients for interobserver reliability ranged from 0.95 to 0.99 for measurements performed on CT and MRI.Conclusion:Measurements of glenoid fracture and associated % bone loss on CT were comparable with measurements obtained using the MR FRACTURE technique. Inter-observer reproducibility for these measurements was excellent. MRI FRACTURE technique may obviate preoperative CT in patients with anterior shoulder instability.

Paper 09: Postage-Stamp Glenoid Fracture after Bankart Repair. How Many Anchors are Safe? - A Biomechanical Analysis

Objectives:Fractures of anterior glenoid rim, aka “Postage-Stamp” fractures, are potential complications of arthroscopic Bankart repairs that occur when a fracture line propagates through previous anchor sites producing a serrated edge. (Fig.1: A and J) Placing multiple anchors adjacent to glenoid rim in attempt to recreate the labral bumper was suggested to reduce the risk of recurrent dislocation after surgery, [Boileau et al 2006] as well as to create a stress riser that may predispose to fracture if another traumatic event may occur.This controlled laboratory study investigated the effect of increased number holes, and different types and sizes of suture anchors on the load necessary to create Postage-Stamp fractures. Our objective was to establish a safe number of anchors that could be inserted in the anterior glenoid rim without incurring in a substantially high risk of fracture.Hypothesis:Increasing the number of holes and anchors and their size would decrease forces necessary to break the anterior glenoid rim.Methods:We tested 46 synthetic scapulae with similar compressive strength and elastic modulus of human glenoid (4th gen. composite scapulae, Sawbones, Pacific Research Laboratories, USA) in a servohydraulic apparatus (Fig.1: B and H) following a previous published biomechanical model. [Farmer et al2014] A guide ensured holes were drilled and anchors were inserted in the same exact angle, depth and location for every specimen. (Fig.1: C to F) A metallic humeral head applied force to the anterior glenoid rim at 1mm/s until fracture occurred. (Fig. 1: G to K) Load-to-fracture of intact glenoid was compared to groups of drilling anchor holes (# 3,4,5,6 and 7) of different diameters (1.6mm and 3mm), and groups with anchors of different sizes and types (1.6mm all-suture and 3mm core anchors).(Fig.1: I to K) One-way ANOVA followed by Turkey post-hoc test compared groups to determine the number of holes necessary to weaken glenoids below 70% of intact value with a p value <0.005.Results:Intact glenoid mean load-to-fracture was 1,238 ± 74N. Drilling 3 to 7 holes of 1.6mm-diameter linearly reduced load to 93%, 89%, 74%, 56% and 52% of intact value respectively, while 3.0mm drill holes reduced load to 87%, 65%, 51%, and 40% respectively.(Fig.2) Directly comparing drill role sizes there were significant differences on the 4, 5 and 7 holes groups (p=0.045, 0.032 and 0.015, respectively), so that a glenoid could safely sustain up to 5 holes of 1.6mm, but no more than 3 holes of 3.0mm-diameter.(Fig.3)Inserting 1.6mm “all-suture” anchors in the 1.6mm-diameter holes did not change the load-to-fracture on the 4 or 5 holes groups (Fig.4A), indicating that the number of drill holes was the main determinant of anterior glenoid rim strength, so that the all-suture anchors did not act as stress risers. Thus, up to 5 “all-suture” 1.6mm anchor could be safely used on a Bankart repair.The 3.0mm “core” anchors increased the load-to-fracture when compared to the group with the same number of holes of the same diameter size. Despite 4 holes of 3.0mm-diameter decreased the load-to-fracture bellow the safety line of 70% of intact value, the group with 4 anchors of 3.0mm-diameter “core” anchors increased load-to-fracture to 85% of intact value (p=0.033).(Fig.4B) This stress shield effect of the 3.0mm core anchor was not noticed on the 5 anchors group, in which the overall strength of the construction was bellow the 70% of intact safety line.Conclusions:Our data call in that up to four 3.0mm “core” anchors or five 1.6mm-diameter “all-suture” anchors could be safely inserted in the anterior glenoid rim without incurring in increased risk of Postage-Stamp fracture. One should prefer small diameter anchors if more than 4 anchors were intended on a Bankart repair.This study contributed to important data about number, size and type of anchors that the anterior glenoid rim could safely sustain in order to avoid postage-stamp fracture in case a new traumatic dislocation episode occur after a Bankart repair, which is of clinical interest in high risk population preoperative planning and selection of implant size, type and number.

Comparison of Rehabilitation Programs Following a Latarjet Procedure: A Level 3 Case Study

OBJECTIVE: Anterior shoulder dislocations cause chronic disability, often requiring surgery. Latarjet procedures are considered when the anterior glenoid fractures during shoulder dislocation. Latarjet procedures show positive outcomes with low dislocation recurrence rates, although rehabilitation guidelines are not well established. This Level-3 CASE report will compare two rehabilitation protocols. UNIQUENESS: Our patient’s progress was significantly delayed compared to Murphy et al.’s patient. Although they had similar strength and ROM deficits in week 2, our patient required an additional 15 weeks to make similar gains. Also, our patient did not begin aggressive overhead activity until 10 weeks after Murphy et al.’s patient. Murphy et al.’s patient returned to limited participation in week 8 and full participation in week 10, while our patient did not return to limited participation until week 16.

Isolated Displaced Glenoid Fracture Caused by Minor Trauma: a Case Report

The glenoid is a shallow structure in the shoulder joint, facing the humeral head and located lateral to the scapula. Glenoid fossa intra-articular fractures account for only 1% of scapular fractures and are associated with high-energy trauma. An 84-year-old female patient admitted to the emergency department with the complaint of pain in her left arm and inability to move her arm as a result of falling over her shoulder from her own level. On the shoulder radiograph of the patient, a suspicious area that could be a fracture in the glenoid rim was observed. CT revealed a displaced fracture line starting from the glenoid rim and extending to the medial wall of the scapula. Velpau bandage was applied to the patient. Elderly female patients should be carefully examined and necessary imaging should be performed, even if they are exposed to a low-energy trauma to the shoulder girdle (such as falling from one's own level). Computed tomography, which is one of the advanced imaging methods, should be applied when a suspicious image of a glenoid fracture is found on the radiography.

Early efficacy analysis on arthroscopic autologous osteochondral grafting in the treatment of recurrent anterior shoulder dislocation

To investigate the early efficacy of arthroscopic autologous osteochondral grafting in the treatment of recurrent anterior shoulder dislocation. From January 2019 to January 2021, 17 patients with recurrent anterior dislocation of shoulder who underwent arthroscopic autologous osteochondral grafting were selected, including 12 males and 5 females, ranging in age from 17 to 55 years old, with a mean of (32.88±12.33) years old. Rowes rating system for Bankart repair(Rowe), Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test (SST) were compared before operation, 6 months after operation and at the latest follow-up. OSIS and SST used to evaluate shoulder function were recorded before surgery and at the latest follow-up. The shoulder mobility and intraoperative and postoperative complications were also recorded. All 17 patients were followed up, and the duration ranged from 7 to 25 months, with a mean of (18.4±5.4) months. During the follow-up period, there was no re-dislocation, no vascular or nerve injury. Rowe score increased from 26.2±6.0 before operation to 74.4±4.0 and 82.4±3.1 after 6 months and the latest follow-up. There was significant difference in Rowe score between different time points after operation and before operation (P<0.05). The OSIS increased from 37.0±3.6 before operation to 47.4±2.6 and 52.7±2.6 after 6 months and the latest follow-up. There was significant difference in OSIS between different time points after operation and before operation (P<0.05). The SST score increased from 6.8±0.7 before operation to 9.8±0.8, 11.6±2.6 after 6 months and the latest follow-up. There was significant difference in SST score between different time points after operation and before operation (P<0.05). At the latest follow-up, the lateral external rotation and abduction external rotation activities of the patient were significantly improved compared with those before operation. This study provides preliminary evidence that arthroscopic autologous osteochondral grafting can achieve satisfactory early clinical outcomes and stability in patients with recurrent anterior shoulder dislocation with glenoid fracture and defect less than <20%, which is a reliable and effective procedure.

Open Screw Fixation of Large Anterior Glenoid Rim Fractures Using a Deltopectoral Approach With Subscapularis Splitting.

Anterior glenoid rim fracture is a consequence of the humeral head impacting the glenoid fossa. The management of large glenoid fractures involving more than 20% of the articulating glenoid requires surgical treatment. The 2 main techniques are open reduction internal fixation (ORIF) by screws and arthroscopic treatment using suture anchors or transcutaneous screws. Next to the technical equipment, a surgeon requires extensive experience to achieve good results with the arthroscopic technique. The main disadvantage using the ORIF technique is the detachment of the subscapularis muscle, which is often criticized for causing functional deficits of the subscapularis. Our study demonstrates the feasibility of the ORIF technique through a deltopectoral approach and splitting of the subscapularis. To our knowledge, subscapularis splitting has never been described to treat glenoid fractures.

A study of the role of locking plates in management of fracture of scapula in adults at tertiary health care center

This study aimed to evaluate the functional outcome of displaced scapular neck, glenoid and body fractures treated by open reduction and internal fixation by locking plate. In this study 10 patients of scapular fracture (neck, glenoid and body) were treated with locking plate at Dr. Hedgewar hospital, Aurangabad from January 2014 to December 2020 with age from 18 to 60 years. Functional outcome was evaluated by Constant-Murley scoring system. Total 10 patients were included in present study. Mean age of the patients was 44.9±11.06 years. Male patients (80%) were common than female patients (20%). Road traffic accident (80%) was most common mode of injury. In fracture type distribution, neck and body of scapula (90%) fracture was most common. Assessment of shoulder function was done using Constant and Murley scoring system. Good function was noted in 80% patients, followed by excellent function in 10% patients and fair function was noted in 10%. Open reduction and internal fixation of displaced scapular (neck, glenoid or body) fracture with locking plate provides good functional outcome.

Scapular Fractures at a Level 1 Trauma Center: A Cross-Sectional Study.

Purpose: Scapular fractures are uncommon injuries that account for up to 1% of all fractures and 5% of all shoulder girdle fractures. Moreover, most of the evidence on the treatment of scapular fractures stems from case series, with paucity of comparative studies. Despite the lack of standardized criteria for the operative treatment of scapular fractures, a set of suggested radiological parameters has been recently reported. The primary aim of this study was to compare the treatment implemented for scapular fractures in comparison with standard published criteria. The secondary aim was to investigate epidemiological parameters of scapular fractures at a level 1 trauma center.Methods: In this cross-sectional study of scapular fractures at a level 1 trauma center, data were collected between December 2012 and January 2016. Data of all scapular fractures that presented to our center were retrospectively collected through electronic medical records. Identified cases of scapular fractures were then evaluated whether surgical treatment was indicated in accordance with recent standard operative criteria. Percentages were used to express the number of cases that were operatively indicated according to the predefined criteria and the number of cases operatively treated at our institution.Results: A total of 52 patients met the inclusion criteria of having scapular fractures documented on radiography and Computed tomography (CT). The mean age of the patients was 38.5 years, with the majority being men (92.3%). The most common mechanism of injury was a fall from a considerable height in 26% of the cases. Of the included patients, 53.8% were polytraumatized, and the most frequent concomitant traumatic injury was rib fractures (26.9%). Only 33% of intra-articular glenoid fractures with significant displacement were treated operatively. Furthermore, non-operative treatment was undertaken in indicated extra-articular scapular body and neck fractures, acromion or coracoid process fractures, or superior shoulder suspensory complex double disruptions.Conclusion: A significant discrepancy was found between the treatments implemented at our institution and the current standard criteria for the operative treatment of scapular fractures. This study emphasizes the need to educate surgeons on scapular fractures and to treat such fractures in accordance with standard published criteria. Furthermore, scapular fractures that require surgery should be referred to a surgeon experienced in scapular fracture fixation.

The Independent Double-Row (IDR) Bony Bankart Repair Technique.

A displaced anterior glenoid rim fracture, the so-called bony Bankart lesion, occurs after a traumatic shoulder dislocation resulting from a high energy trauma and is associated with recurrent shoulder instability. Different surgical techniques have been described in the literature to address this pathology, including open reduction and fixation, as well as arthroscopic transosseous, and single-row or double-row approaches with the use of suture anchors. However, there is currently no gold standard of treatment and the stability of fixation and the healing of the bony fragment are still a concern. The purpose of this report was to introduce an arthroscopic independent double-row (IDR) bony Bankart repair technique for fixation of large glenoid fractures.

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

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.