Treatment Of Glenoid Rim Fractures Research Articles

Instability and results after non-operative treatment of large anterior glenoid rim fractures: is there a correlation between fragment size or displacement and recurrence?

IntroductionThere is little data available on non-operative treatment of anterior glenoid rim fractures (GRF). Nothing is known about fracture size and displacement in comparison to clinical outcomes and instability in a mainly middle-aged patient population. The aim of this study was to demonstrate the results of non-operative treatment in anterior glenoid rim fractures with the special focus on potential instability/recurrence.MethodsThe inclusion criteria were non-operatively treated anterior GRF of at least ≥ 5 mm width using the age- and gender-matched Constant/Murley score (a.-/g.-CMS) and the Western Ontario Instability Index (WOSI). Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill–Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. and axial radiographs) was classified according to Samilson/Prieto. Proportion of fractured glenoid and medial displacement were correlated with the recurrence rate and the clinical scores.ResultsN = 36 patients could be followed-up after a mean of 4.4 years [12–140 month, average age: 58 (± 13, 33–86) years]. The a.-/g.-CMS was 93 (± 11, 61–100) points, and the WOSI was 81% (± 22%, 35–100%) on average. The mean intraarticular displacement was 4 mm (± 3 mm; 0–14 mm). The 2D-circle-method showed a mean glenoid fracture involvement of 21% (± 11, 10–52%). Two cases of frozen shoulders and one case with biceps pathology were associated with the trauma. Within the followed-up patient group re-instability has occurred in n = 2 patients (6%) within the first two weeks after trauma. Osteoarthritis was found in n = 11 cases. There was no correlation between the scores and the fracture size/displacement [(a.-/g.-CMS vs. displacement: r = − 0.08; p = 0.6; vs. size: r = − 0.29; p = 0.2); (WOSI vs. displacement: r = − 0.14; p = 0.4; vs. size: r = − 0.37; p = 0.06)], but very large (≥ 21%) fractures with displacement ≥ 4 mm showed slightly worse results without significant difference (a.-/g.-CMS p = 0.2; WOSI p = 0.2). The apprehension test was negative in all patients at final follow-up.ConclusionNon-operative treatment of anterior GRF was associated with overall good results within a mainly middle-aged larger patient group. Re-instability is rare and is not associated with fragment size but can occur in the first weeks after trauma. Size and dislocation of the fracture is not a criterion for the prognosis of potential instability.Level of evidenceLevel IV, retrospective case series.

Acute Fractures of the Glenoid.

Glenoid fractures are unique in which they span the fields of orthopaedic traumatology and sports medicine. Treatment of glenoid fractures, whether surgical or nonsurgical, may be challenging and have long-term implications on pain and shoulder function. Plain radiographs are always indicated, and most glenoid fractures will require advanced imaging in the form of CT scan. Two general categories of glenoid fractures exist and differ in mechanism of injury, fracture morphology, and treatment. The first category is glenoid fractures with extension into the scapular neck and body. These fractures are typically from high-energy trauma and are often associated with other orthopaedic and nonorthopaedic injuries. The second category includes glenoid rim fractures, which are typically consequent of lower energy mechanisms and are associated with shoulder instability events. Treatment of glenoid rim fractures is dictated by the size and displacement of the fracture fragment and may be nonsurgical or surgical with either open and arthroscopic techniques. The purpose of this review was to discuss the current evidence on glenoid fractures regarding diagnosis, classification, management, and outcomes.

All-Arthroscopic Treatment of Glenoid Rim Fractures

We describe an arthroscopic technique for the management of glenoid rim fractures. It is performed with the patient placed in lateral decubitus position. The fracture is assessed through the anterosuperior portal, and the fragment is mobilized. A special glenoid guide is used from the posterior portal to reduce the fragment and to create 2 tunnels through the glenoid and through the glenoid rim fragment. Two pairs of round buttons are connected with high-strength sutures and are tightened posteriorly. This allows strong fixation of the fractured fragment and avoids all the anterior structures since all the instruments are inserted posteriorly.

Bony Bankart lesions and glenoid defects : From refixation techniques to bony augmentation

Rim defects of the anterior glenoid cavity are amain reason for residual shoulder instability after traumatic dislocation of the shoulder. These defects can be the result of aglenoid rim fracture or chronic glenoid erosion after repeated shoulder dislocations. Treatment concepts for these entities are entirely different. While in the acute fracture situation glenoid rim fractures can be treated operatively or non-operatively, augmentation of the anterior glenoid for stabilization of the shoulder should be considered if the defect exceeds 15-25% of the anterior glenoid. The purpose of this article is to summarize the diagnostics and indications for treatment of glenoid rim fractures. Radiological assessment and options for augmentation are reviewed for both acute fractures as well as chronic instability following an anterior glenoid rim defect.

Arthroscopic reconstruction of a complex glenoid rim fracture using suture anchors

The gold standard for the treatment of large displaced glenoid rim fractures has been open reduction and internal fixation using cannulated screws. With the advancement in arthroscopic techniques there has been a growing trend towards arthroscopic treatment of glenoid rim fractures. This report outlines the case of 39-year-old health men who sustained a complex multifragmented displaced glenoid rim fracture after a fall on the right shoulder. The injury was diagnosed by standard radiographs and 3D-CT. An arthroscopic reconstruction including closed reduction and internal fixation using suture anchors was performed. After a follow-up of 1 year the Constant Score was 94 points, the Rowe Score 100 points and the Western Ontario Shoulder Instability Index was 99.9 points. In the Simple Shoulder Test all questions were answered with “yes”. At the latest follow-up the patient was completely painfree and regained a full work activity level. On postoperative 3D-CT imaging the fracture was consolidated in an almost anatomic position with a nearly complete reconstruction of the inferior glenoid circle. In cases of displaced glenoid rim fractures closed reduction and arthroscopic reconstruction using suture anchors can lead to excellent clinical and radiological results.

Treatment of Glenoid Rim Fractures of the Scapula

Treatment of Glenoid Rim Fractures of the Scapula