Glenoid Fractures Research Articles

Clinical and radiographic outcomes of open Latarjet procedure in patients aged 40 years or older

The Latarjet procedure is often used to treat shoulder instability in younger patients. Little is reported on the outcomes of this procedure in older (≥40 years) populations. The purpose of this study was to evaluate the clinical and radiographic outcomes of patients aged 40 years or older with recurrent anterior shoulder instability who underwent open Latarjet stabilization. A total of 168 patients aged 40 years or older were treated surgically for recurrent anterior shoulder instability with an open Latarjet procedure between 1988 and 2014. Bankart lesions or anteroinferior glenoid fractures were confirmed preoperatively with a computed tomography arthrogram. Outcomes were assessed with preoperative and postoperative physical examinations, clinical outcome scoring, and radiographic examinations. Ninety-nine patients with complete data were available with a mean follow-up period of 13 years (range, 3-23 years). At the time of final follow-up, 94% of patients did not have recurrence of instability. Of the patients, 90% were satisfied or very satisfied with their outcomes and 54% returned to their preinjury level of activity. The overall complication rate was 21% (the most common complications being subjective apprehension [9%] and recurrent instability [6%]), with 9% of patients requiring reoperation. A full-thickness rotator cuff requiring repair was identified in 22% of patients. The Latarjet procedure is an effective treatment option for older patients (aged ≥ 40 years) with recurrent anterior shoulder instability in the setting of an anteroinferior capsulolabral and/or bony injury.

Fractures Around the Shoulder: Radiologic Update on Surgical Fixation Techniques.

Although radiologists are likely familiar with basic fracture patterns around the shoulder, certain fracture types in this area have particularly relevant and controversial clinical management issues. These include proximal humeral fractures, in which conservative management is favored but some patients receive surgical treatment; glenoid fractures and Hill-Sachs lesions, in which surgery may be performed depending on the amount of bone loss; and distal clavicular fractures, in which certain displaced fractures have high rates of nonunion, but there is no clearly favored surgical technique. Knowledge of the different clinical issues and surgical options can aid the radiologist in identifying key imaging findings and creating a useful report.

Clinical outcomes and complications of cementless reverse total shoulder arthroplasty during the early learning curve period

BackgroundReverse total shoulder arthroplasty (RTSA) is a treatment option for patients with severe osteoarthritis, rotator cuff arthropathy, or massive rotator cuff tear with pseudoparalysis. We are to deduce not only the early functional outcomes and complications of cementless RTSA during the learning curve period but also complication-based, and operation time-based learning curve of RTSA.MethodsBetween March 2010 and February 2014, we retrospectively evaluated 38 shoulders (6 male, 32 female). The average age of the patients was 73.0 years (range, 63 to 83 years), and the average follow-up was at 24 months (range, 12–53 months). The visual analog scale (VAS), University of California Los Angeles (UCLA) score and constant score were used to evaluate the clinical outcomes. We evaluated patients radiographically at 2 weeks, 3 months, 6 months, 1 year, and then annually thereafter for any evidence of complications.ResultsThe VAS score improved from 4.0 to 2.8 (p = 0.013). The UCLA score improved from 16.0 to 27.9 (p = 0.002), and the constant score improved from 41.4 to 78.9 (p < 0.001), which were statistically significant. While active forward flexion, abduction, and internal rotation improved (p value = 0.001, < 0.01, 0.15), external rotation did not show significant improvement (p = 0.764). Postoperative complications included acromion fracture (one case), glenoid fracture (one case), peripristhetic humeral fracture (one case), axillary nerve injury (one case), infection (one case), and arterial injury (one case). Our study presented an intraoperative complication-based learning curve of 20 shoulders, and operation time-based learning curve of 15 shoulders.ConclusionsThe clinical outcomes of RTSA were satisfactory with overall complication rates of 15.7%. An orthopedic surgeon within the learning curve period for the operation of RTSA should be cautious when selecting the patients and performing RTSA.Trial registrationRetrospectively registered.

Clinical Results and Complications of Shoulder Manipulation under Ultrasound-Guided Cervical Nerve Root Block for Frozen Shoulder: A Retrospective Observational Study.

IntroductionManipulation under ultrasound-guided fifth and sixth cervical nerve root block (MUC) is a recognized form of treatment for patients with persistent frozen shoulder (FS). This study aimed to investigate the confirmatory hypothesis testing that the MUC has a significant clinical effect on FS refractory to conservative treatments and to assess its adverse events.MethodsThis is a retrospective observational study on patients with FS treated in the past 8 years. Although 77 patients were eligible for this study, only 68 were enrolled. The patients were evaluated immediately before the MUC and at 1, 3, and 6 months after with the use of the Japanese Orthopaedic Association shoulder score. Simultaneously, ranges of motion of the affected shoulder were measured in two directions: forward flexion and external rotation. A paired t test or a Wilcoxon signed-rank test was used to compare differences in outcomes between before and 6 months after MUC. We also assessed any adverse events during and after the MUC.ResultsRegarding the primary outcome, confirmatory testing showed statistically significant improvements in every outcome value at 6 months after MUC (p < 0.001). In terms of adverse events, two patients (2.9%) had vasovagal reflex, one (1.5%) had a panic attack during the block procedure, and a 72-year-old female patient (1.2%) had an avulsion fracture of the inferior glenoid during the manipulation procedure, although all of them recovered spontaneously without any residual functional impairment.ConclusionThe results showed that significant clinical effects of the MUC on FS were observed through a confirmatory analysis with a sufficient sample size. However, several complications that could occur during the block and manipulation procedures should be considered.

Biomechanical properties of transosseous bony Bankart repair in a cadaver model

IntroductionWe compared two arthroscopic repair techniques to an intact shoulder using a biomechanical model of anterior shoulder dislocation with an anterior glenoid rim fracture (Ideberg IA fracture). We hypothesized that transosseous repair is sufficient to effectively stabilize the glenoid fracture. The primary objective was to define the mechanical properties of transosseous repair of an Ideberg IA fracture relative to an intact shoulder (control group). The secondary objective was to determine the contribution of supplemental anteroposterior screw fixation of the bone fragment. Materials and methodsFifteen fresh cadaver shoulders were divided into two groups: 5 specimens in the control group and 10 in the fracture fixation group, with sequential performance of transosseous repair followed by transosseous repair+screw fixation. A fracture at the inferior portion involving more than 30% of the glenoid's surface area was made. ResultsThe load to failure was 457 N in the control group, 277 N in the transosseous repair group and 325 N in the transosseous repair+screw fixation group. The stiffness of the constructs was 26.2N/mm for the control group, 14.6N/mm for transosseous repair and 24.6N/mm for transosseous repair+screw fixation. The difference between the two repair techniques was significant for the load to failure (p=0.02) and stiffness (p=0.001). Discussion/ConclusionThis study showed that transosseous repair restores the shoulder's anatomy but not the mechanical strength of the native glenoid. Adding screw fixation significantly improves the construct. Level of evidenceIV, basic science study.

A retrospective analysis of extra articular glenoid neck fracture of scapula (A study of 20 cases)

Introduction: Since long ago the scapula fracture is treated conservatively and most of time it works because scapula is a flat bone and coated with bulky muscle. So, nonunion of the fracture is usually not a problem, and most of time, due to very high arc of motion of shoulder joint, even in malunited fractures, mild to moderate restriction of the range of motion not create significant problem. But the actual problem comes when fracture through the glenoid neck or glenoid fossa cause derangement in the biomechanics of shoulder joint, or associated fracture of clavicle – ‘The floating shoulder’ cause significant instability of shoulder joint. Recent advances and proper understanding of the biomechanics of the shoulder joints open a new chapter of operative management for better quality of life.In this study we retrospectively tried to understand that which fractures can be treated conservatively and which one require fixation.Aim: To study retrospectively extraarticular glenoid neck fractures of scapula (a study of 20 cases).Materials and Methods: Total 20 patients having extra articular scapular neck fracture, with following criteria are included in this study. All patients were treated by consultant orthopedic surgeons of the department of orthopedics of Guru Gobindsingh Hospital, Jamnagar only. All patients are evaluated retrospectively. Patients having fracture of appendicles (Fracture of acromion, coracoid and spine), body as well as intra articular glenoid fracture were not included in this study. So this study was concerned only with stable and unstable scapular neck fracture. All patients are evaluated with Herscovici shoulder scoring system to make this study comparable with other study universally.Results: Our study shows excellent results in 16 out of 20 scapular fractures as well as 4 good results, according to Herscovici shoulder scoring system. Most common complication is subacromial pain especially at night while sleeping on that side. Incidence of mild exertional pain is 45% while loss of useful abduction was 10% and superficial infection is 5%.Conclusion: To conclude, this rare type of fracture has high incidence of significant associated injury. Among all scapular fractures extra articular displaced glenoid fracture and floating shoulder type injury should get special attention regards of its treatment, because closed observation and intelligence can make vast change in its outcome.

The evaluation of cases of glenoid fractures after operation

The evaluation of cases of glenoid fractures after operation

The Relationship between Clinical Findings of Shoulder Joint with Bone Damage of Shoulder Joint in Patients with Isolated Shoulder Blunt Trauma.

BACKGROUND:Due to the prevalence of shoulder injuries among athletes and other people and the prevalence of radiography for these injuries, there are still no valid criteria for indication of doing shoulder radiography.AIM:This study aimed to examine the relationship between some signs and clinical examinations of the shoulder with shoulder bone injuries and the need for radiography.METHODS:This is a cross-sectional study. All patients aged 18-70 years who referred to the emergency ward of Imam Reza and Hasheminejad Hospital in the year 2014 due to blunt trauma and had criteria for entering the study and lacking exclusion criteria were included in the study process. Data on clinical symptoms, radiographic results, and final diagnosis were extracted from the patients’ records through a questionnaire and analysed statistically.RESULTS:There was a significant relationship between the clinical signs of patients Existence of ecchymosis in the shoulder fractures with glenoid and humerus fractures (p = 0.029, p = 0.004 respectively). There was also a significant relationship between clavicle fracture and limitation in shoulder rotation and abduction (p = 0.000 and p = 0.001 respectively). Other clinical symptoms did not show any significant relationship with radiographs indicative of the problem requiring specific treatment.CONCLUSION:Although it is possible to define critters based on clinical symptoms that reduce the need for unnecessary radiographs that the does not reliably help inpatient treatment, but finding these critters to indicate the performance of the graphs in shoulder injuries requires further studies with the higher population and more clinical variables.

Arthroscopic repair of glenoid rim fractures: a ligamentotaxis surgical technique.

Glenoid fractures occur as a result of direct impact of the humeral head against the glenoid rim following high-energy trauma. They frequently involve one-third of the glenoid surface with an oblique fracture rim from 2 to 6-7 o'clock, and they must not be confused with bony Bankart lesions. In medium-age patients, they are frequently associated with acute cuff tear while in older patients with chronic cuff tear: These conditions increase the instability of the shoulder if not treated. With this study, we reported the results of the arthroscopic ligamentotaxis technique treatment of acute antero-inferior glenoid fractures type IA of Ideberg with a cuff repair associated. Eleven patients with IA Ideberg glenoid fracture were treated with ligamentotaxis technique. Mean age: 56years (45-70); 80% dominant side; male/female: 1.2. Mean extension area of glenoid fracture: 25%. The fragment was fixated reinserting the labro-ligamentous complex with a single 2o'clock anchor. In six patients (55%), a rotator cuff tear was present, repaired during the surgical intervention. Radiological assessment: X-rays and CT with PICO method to measure the glenoid area involved. Clinical assessment: VAS, constant score, Dash score and Rowe score. After 30months of follow-up (12-50), no differences in flexion, abduction, rotations and pain were reported compared to the contralateral side (p > 0.05). The mean normalized constant was 101 (60-123), and the mean Rowe was 93 (65-100). X-rays showed good healing without articular surface depressions or step in all cases. Two patients had a progression of gleno-humeral arthritis. Acute antero-inferior glenoid rim fractures are uncommon but they are increasing in over 55years population (frequently associated with cuff tear). Correct classification and treatment are necessary to achieve good results. The X-ray assessment includes the Neer's trauma series and the CT study with PICO measurement of glenoid fragment size. Wrong treatment can lead to chronic instability, degenerative joint disease and poor results. The arthroscopic repair with ligamentotaxis is a good solution and permits the treatment of the associated rotator cuff tear. Arthroscopic technique imposes a long learning curve. CT can be used to confirm the anatomic reduction and the healing of the fracture but since it uses X-rays it must be reserved to comminuted fractures.

Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery

This study assessed the clinical and radiologic outcomes of Ideberg type IA glenoid fractures treated using conventional open surgery compared with those treated with arthroscopic surgery. This was a retrospective, multicenter study of anterior glenoid rim fractures (Ideberg IA) treated with conventional open surgery (group O) or arthroscopic surgery (group A). Included were 56 patients: 10 in group O and 46 in group A. The patients were reviewed after a minimum of 12 months of follow-up. The Constant score was used as an objective clinical outcome. Radiographs were reviewed to assess the quality of the postoperative reduction, fracture healing, complications, and whether osteoarthritis was present at the last follow-up. At a mean follow-up of 30 months (range, 12-115 months), there was no significant difference between the groups based on the Constant Score (group O: 74 points; group A: 84 points, P = .07). None of the shoulders showed signs of instability. Conversely, the rate of postoperative complications was higher in group O than in group A (30% vs. 4%; P = .03). Glenohumeral osteoarthritis was found in 10% of group O patients and 18% of group A patients (P = .65). This study shows that anterior glenoid rim fractures have similar functional outcomes, whether treated using conventional open surgery or arthroscopic surgery. Arthroscopic surgery appears to reduce the complication and reoperation rate.

Epidemiological survey of scapular neck fractures between the east and west areas in China from 2010 through 2011

Objective To compare the epidemiological characteristics of glenoid fractures between the east and west areas in China from 2010 through 2011. Methods The data of glenoid fractures treated between January 2010 and December 2011 at 35 east hospitals and 28 west ones in China were analyzed retrospectively. The patients’ gender, age and type of Ideberg classification were documented. The data from the 35 east hospitals were classified as group A while those from the 28 west ones as group B. Comparisons were made to find out the general epidemiological characteristics. Results A total of 347 glenoid fractures were collected. The total male/female ratio was 2.69∶1. The glenoid fractures predominated in 2 age ranges from 41 to 50 years and from 51 to 60 years (19.60%). According to the Ideberg classification, there were 75 cases (21.61%) of type Ⅰ, 152 ones (43.80%) of type Ⅱ, 27 ones (7.78%) of type Ⅲ, 20 ones (5.76%) of type Ⅳ, 46 ones (13.26%) of type Ⅴ and 27 ones (7.78%) of type Ⅵ. The male/female ratio was 2.80∶1 in group A of 228 patients and 2.50∶1 in group B of 119 patients. The median age of group A was 47 years old and that of group B 44 years old. The differences were not statistically significant in male/female ratio, median age or distribution of age between the 2 groups (P>0.05). The fractures predominated in the age range from 51 to 60 years old (23.68%) in group A and in the age range from 31 to 40 years old (21.85%) in group B. The most frequent fracture type was type Ⅱ in both groups, accounting for 41.23% and 48.74% respectively. There was a significant difference between the 2 groups in distribution of Ideberg classification (P< 0.05). Conclusions The peak age of glenoid fractures was from 41 to 60 years, the high-risk type was Ideberg type Ⅱ and there were more male patients than female ones. The proportion of Ideberg type Ⅴ in the east area was higher than that in the west area. Key words: Shoulder fractures; Epidemiology studies; Small-area analysis; Sex distribution; Age distribution

Complications of reverse shoulder arthroplasty

Reverse shoulder arthroplasty is a common treatment for shoulder disorders. Complication rates after reverse shoulder arthroplasty are significantly higher than that of conventional total shoulder arthroplasty especially in high risk patient populations. Complications include instability, intra-operative glenoid fractures, intra-operative humeral fractures, acromial fractures, neurologic injury, infection, baseplate failure, humeral stem loosening, component dissociation, dislocation, and scapular notching. Recognition of risk factors, thorough understanding of the mechanics of the reverse arthroplasty and techniques for implantation, and pre-operative planning are essential in optimizing patient outcome and intra-operative success. Failure of reverse shoulder arthroplasty is a significant challenge requiring appropriate diagnosis of the failure mode.

Intra- and interobserver reliability of glenoid fracture classifications by Ideberg, Euler and AO

BackgroundRepresenting 3%–5% of shoulder girdle injuries scapula fractures are rare. Furthermore, approximately 1% of scapula fractures are intraarticularfractures of the glenoid fossa. Because of uncertain fracture morphology and limited experience, the treatment of glenoid fossa fractures is difficult. The glenoid fracture classification by Ideberg (1984) and Euler (1996) is still commonly used in literature. In 2013 a new glenoid fracture classification was introduced by the AO. The purpose of this study was to examine the new AO classification in clinical practice in comparison with the classifications by Ideberg and Euler.MethodsIn total CT images of 84 patients with glenoid fossa fractures from 2005 to 2018 were included. Parasagittal, paracoronary and axial reconstructions were examined according to the classifications of Ideberg, Euler and the AO by 3 investigators (orthopedic surgeon, radiologist, student of medicine) at three individual time settings. Inter- and intraobserver reliability of the three classification systems were ascertained by computing Inter- and Intraclass (ICCs) correlation coefficients using Spearman’s rank correlation coefficient, 95%-confidence intervals as well as F-tests for correlation coefficients.ResultsInter- and intraobserver reliability for the AO classification showed a perspicuous coherence (R = 0.74 and R = 0.79). Low to moderate intraobserver reliability for Ideberg (R = 0.46) and Euler classification (R = 0.41) was found. Furthermore, data show a low Interobserver reliability for both Ideberg and Euler classification (R < 0.2). Both the Inter- and Intraclass reliability using AO is significantly higher than those using Ideberg and Euler (p < 0.05). Using the new AO classification, it was possible to find a proper class for every glenoid fossa fracture. On average, according to Euler classification 10 of 84 fractures were not classifiable whereas to Ideberg classification 21 of 84 fractures were not classifiable.ConclusionThe new AO classification system introduced 2013 facilitates reliable grading of glenoid fossa fractures with high inter- and intraobserver reliability in 84 patients using CT images. It should possibly be applied in order to enable a valid, reliable and consistent academic description of glenoid fossa fractures. The established classifications by Euler and Ideberg are not capable of providing a similar reliability.

Reverse total shoulder arthroplasty using helical blade to optimize glenoid fixation and bone preservation: preliminary results in thirty five patients with minimum twoyear follow-up.

Glenoid loosening is a common cause of reverse total shoulder arthroplasty (RTSA) failure, and grafting of the glenoid is often required for revision due to bone loss due to the central peg in most glenoid baseplates. Helical blades have been used in the hip to optimize bone fixation in proximal femoral fracture. This study presents the initial results of specifically designed helical blade in the shoulder to optimize glenoid bone fixation and preservation as part of RTSA. Thirty-five patients underwent RTSA with glenoid helical blade fixation. An uncemented glenoid baseplate was used with a central helical blade partially coated with hydroxyapatite and two or three screws. Outcome analysis was performed pre-operatively and at twoyears. All patients were satisfied with the results and significant improvement was observed in functional outcome scores between baseline and final follow-up. There was a single intra-operative undisplaced glenoid fracture which did not compromise the baseplate fixation. There was no radiographic evidence of loosening or radiolucencies around the helical blade. The helical blade provides a satisfactory primary fixation. Because of its length (21mm), care should be taken in cases of pre-existing bone loss or sclerotic bone to avoid glenoid fracture or anterior cortical perforation. Helical blade has the potential to facilitate glenoid implant revision by preserving the glenoid bone stock.

Feasibility of using an inversion-recovery ultrashort echo time (UTE) sequence for quantification of glenoid bone loss.

To utilize the 3D inversion recovery prepared ultrashort echo time with cones readout (IR-UTE-Cones) MRI technique for direct imaging of lamellar bone with comparison to the gold standard of computed tomography (CT). CT and MRI was performed on 11 shoulder specimens and three patients. Five specimens had imaging performed before and after glenoid fracture (osteotomy). 2D and 3D volume-rendered CT images were reconstructed and conventional T1-weighted and 3D IR-UTE-Cones MRI techniques were performed. Glenoid widths and defects were independently measured by two readers using the circle method. Measurements were compared with those made from 3D CT datasets. Paired-sample Student's t tests and intraclass correlation coefficients were performed. In addition, 2D CT and 3D IR-UTE-Cones MRI datasets were linearly registered, digitally overlaid, and compared in consensus by these two readers. Compared with the reference standard (3D CT), glenoid bone diameter measurements made on 2D CT and 3D IR-UTE-Cones were not significantly different for either reader, whereas T1-weighted images underestimated the diameter (mean difference of 0.18cm, p=0.003 and 0.16cm, p=0.022 for readers 1 and 2, respectively). However, mean margin of error for measuring glenoid bone loss was small for all modalities (range, 1.46-3.92%). All measured ICCs were near perfect. Digitally registered 2D CT and 3D IR-UTE-Cones MRI datasets yielded essentially perfect congruity between the two modalities. The 3D IR-UTE-Cones MRI technique selectively visualizes lamellar bone, produces similar contrast to 2D CT imaging, and compares favorably to measurements made using 2D and 3D CT.

Arthroscopic fracture treatment of the shoulder joint

In recent years, the understanding of shoulder fractures has changed due to the progress of arthroscopy. In addition to the cosmetic result, the access morbidity, particularly the integrity of the subscapularis muscle in glenoid and scapular fractures, must be mentioned as an advantage of aminimally invasive approach. Furthermore, necessary secondary interventions, e. g. hook plate removal, can be prevented or minimized by modern implants and arthroscopic techniques.However, the available data and publications are almost exclusively limited to technical notes or small case series, so statements about faster recreation or potential reduction of infection risk cannot be made. Whether addressing concomitant injuries has an effect on the clinical and functional outcome is also unclear at the present time.

Treatment of scapular fractures with lateral incision and bridge combined internal fixation system

To investigate the clinical results of scapula fractures with lateral incision combined with bridge internal fixation system. From October 2012 to December 2016, 20 cases of scapular fractures were treated through the lateral incision combined with bridge fixation system, including 15 males and 5 females, with an average age of 31.6 years old(ranged, 21 to 52 years old). Fourteen cases were scapular body fracture, 10 were scapular neck fracture, 6 were scapular fracture, 1 was acromion fracture, 1 was coracoid fracture, 4 were the glenoid rim fracture, 3 were the glenoid fossa fracture. The operation time ranged from 4 to 15 d after injury with an average of 10 d. All 20 cases were followed up for 3 to 24 months with an average of 15 months. Wound infection occurred in 2 cases after operation, and was healed after wound debridement and change dressing; no osteomyelitis, iatrogenic nerve injury, breakage of internal fixation, fracture displacement, joint stiffness occurred. Callus growth was observed at the fracture site 3 months after operation, the fracture healing time was 4 to 7 months, fracture healing was good without delayed union or malunion. According to Hardegger shoulder score, the results were excellent in 12 cases, good in 6 cases, moderate in 2 cases. Lateral incision approach combined with bridge internal fixation system for scapula fractures has the advantages of easy operation, revealed clearly, and the incision can be arbitrary to extend on both sides, to provide favorable conditions for the reduction and fixation of fracture. Bridge combined internal fixation system has the advantages of flexible operation, reliable fixation strength, is a good choice for treatment of scapula fracture.

Arthroscopic-assisted Reduction and Percutaneous Screw Fixation for Glenoid Fracture with Scapular Extension

Arthroscopic-assisted Reduction and Percutaneous Screw Fixation for Glenoid Fracture with Scapular Extension

Painful posterior shoulder instability: Anticipating and preventing failure. A study in 25 patients

BackgroundPainful posterior shoulder instability (PPSI) is the least common of the three clinical patterns of posterior shoulder instability. PPSI is defined as pain combined with anatomical evidence of posterior instability but no instability events. Material and methodWe studied a multicentre cohort of 25 patients with PPSI; 23 were identified retrospectively and had a follow-up of at least 2 years and 2 patients were included prospectively. Most patients engaged in sports. ResultsAll 25 patients underwent surgery, which usually consisted in arthroscopic capsulo-labral reconstruction. The outcome was excellent in 43% of patients; another 43% had improvements but reported persistent pain. The pain remained unchanged or worsened in the remaining 14% of patients. Causes of failure consisted of a missed diagnosis of shoulder osteoarthritis with posterior subluxation, technical errors, and postoperative complications. The main cause of incomplete improvement with persistent pain was presence of cartilage damage. ConclusionOutcomes were excellent in patients who were free of cartilage damage, bony abnormalities associated with posterior instability (reverse Hill–Sachs lesion, erosion or fracture of the posterior glenoid), technical errors, and postoperative complications.

Postoperative Recurrence of Instability Due to New Anterior Glenoid Rim Fractures After Arthroscopic Bankart Repair

Background: Computed tomography (CT) sometimes reveals a new fracture of the anterior glenoid rim in patients with postoperative recurrence of instability after arthroscopic Bankart repair using suture anchors, but there have been few previous reports about such fractures. Hypothesis: The placement of a large number of suture anchors during arthroscopic Bankart repair might be associated with a new glenoid rim fracture. Study Design: Cohort study; Level of evidence, 3. Methods: Screw-in metal suture anchors were used until June 2011 and suture-based soft anchors from July 2011. A follow-up of at least 2 years was conducted for 128 shoulders treated using metal anchors (metal anchor group) and 129 shoulders treated using soft anchors (soft anchor group). The frequency and features of new glenoid rim fractures were investigated, and the influence of the number of suture anchors and other factors on fractures was also assessed. Results: There were 19 shoulders (14.8%) with postoperative recurrence in the metal anchor group and 23 shoulders (17.8%) in the soft anchor group. Among 37 shoulders evaluated by CT at recurrence, a new glenoid rim fracture was detected in 13 shoulders (35.1%; 5 shoulders in the metal anchor group and 8 shoulders in the soft anchor group). A fracture at the anchor insertion site was recognized in 4 shoulders from the metal anchor group and 6 shoulders from the soft anchor group, although linear fractures connecting several anchor holes were only seen in the soft anchor group. While new glenoid fractures occurred regardless of the number of suture anchors used, new fractures were significantly more frequent in teenagers at surgery and in junior high school or high school athletes. Such fractures did not only occur in contact athletes but were also found in overhead athletes. Conclusion: Postoperative recurrence of instability associated with a new glenoid rim fracture along the suture anchor insertion site was frequent after arthroscopic Bankart repair. These fractures might be related to placing multiple soft suture anchors in a linear arrangement.