1
|
Chalidis B, Papadopoulos PP, Papadopoulos P, Pitsilos C. The Role of Arthroscopy in Contemporary Glenoid Fossa Fracture Fixation. Diagnostics (Basel) 2024; 14:908. [PMID: 38732322 PMCID: PMC11083719 DOI: 10.3390/diagnostics14090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Glenoid fossa fractures are rare injuries accounting for 10 to 29% of all intra-articular scapula fractures. They are usually the result of high-energy trauma, and concomitant injuries are not uncommon. Patients with glenoid fractures are admitted with shoulder pain and restricted range of motion. Although shoulder plain radiographs could establish the diagnosis, a computed tomography scan is necessary to adequately define the fracture pattern and characteristics. The most commonly used classification system is that of Ideberg (modified by Goss), which includes five glenoid fossa fracture types according to the location, extension, and complexity of the lesion. Articular surface displacement and step-off are the most important factors that should be taken under consideration when deciding for conservative or surgical management. Operative treatment includes open reduction and internal fixation through a posterior or anterior approach depending on fracture morphology and displacement. However, open surgical techniques are related to extensive soft-tissue disruption, risk of neurovascular injury, and inadequate exposure of the entire glenoid cavity. Introduction of arthroscopy could facilitate better visualization of the glenoid articular surface and improved fracture reduction. However, it is a technically demanding procedure with many challenges and pitfalls. The aim of this review is to summarize the current evidence regarding the treatment of glenoid fossa fractures and present the beneficial effect of arthroscopy in improving the quality of fracture fixation and overall functional outcomes.
Collapse
Affiliation(s)
- Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Polychronis P. Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
| | - Charalampos Pitsilos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
| |
Collapse
|
2
|
Giordano V, Pires RE, Labronici PJ, Vieira I, de Souza FS, Sassine TJ, Mendes AF, Freitas A. 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. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:571-580. [PMID: 36094673 DOI: 10.1007/s00590-022-03389-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION 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. METHODS 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 6-10 weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10 weeks, 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. RESULTS 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 4.8 years. 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. CONCLUSION 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. LEVEL OF EVIDENCE IV Therapeutic Study (Surgical technique and Retrospective cohort).
Collapse
Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil.
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Pedro José Labronici
- Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Igor Vieira
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil
| | - Felipe Serrão de Souza
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil
| | - Tannous Jorge Sassine
- Departamento de Ortopedia, Escola de Medicina, Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | - Adriano Fernando Mendes
- Hospital Universitário, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | |
Collapse
|
3
|
Wafaisade A, Karwatzke A, Kappel P. Arthroskopische Frakturversorgung am Glenoid. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-023-00599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
|
4
|
Gambhir N, Alben MG, Larose G, Virk MS. Short-term outcomes of instability related anterior glenoid fractures treated with open repair utilizing subscapularis split technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03424-7. [PMID: 36348100 DOI: 10.1007/s00590-022-03424-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The purpose of this series is to report on the one-year clinical outcomes of instability related anterior glenoid fractures treated with open repair utilizing the subscapularis split technique. METHODS Patients with displaced anterior glenoid fractures who underwent open surgical treatment via deltopectoral incision and subscapularis split were identified from a single surgeons database. Fractures were repaired using screw fixation or with distal tibia osteochondral allograft reconstruction. Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test (UE), PROMIS Pain interference (PI), PROMIS pain intensity (Pi), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain, and Subjective Shoulder Value (SSV) scores were obtained at minimum one-year follow-up. RESULTS Twelve patients with a mean age of 54 (range 28-72) years were included in our study with a follow-up at an average of 16.6 (range 12-30) months. Ten patients underwent internal fixation and two patients underwent allograft reconstruction. Postoperative imaging (n = 10) at latest follow-up demonstrated healed fractures without any hardware complication. Mean postoperative range of motion included forward elevation of 147 ± 44.0° and external rotation of 44 ± 17°. Postoperative PROMs were obtained from nine patients with a mean PROMIS UE, PI, and Pi score of 49.4 ± 4.1, 39.9 ± 3.8 and 35.6 ± 4.3, respectively. The respective mean ASES, VAS, and SSV scores were 91.8 ± 7.2, 1.2 ± 1.0, and 91.0 ± 8.0. CONCLUSION Open surgical repair of anterior glenoid fractures utilizing subscapularis split results in good functional outcomes and low complications including risk of recurrent instability. LEVEL OF EVIDENCE III case series.
Collapse
Affiliation(s)
- Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital -NYU Langone Health, 333 East 38th Street, New York, NY, 10016, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital -NYU Langone Health, 333 East 38th Street, New York, NY, 10016, USA
| | - Gabriel Larose
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital -NYU Langone Health, 333 East 38th Street, New York, NY, 10016, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital -NYU Langone Health, 333 East 38th Street, New York, NY, 10016, USA.
| |
Collapse
|
5
|
Pfister G, Murison JC, Sabate-Ferris A, Danis J, De l'Escalopier N, Mathieu L. Open Screw Fixation of Large Anterior Glenoid Rim Fractures Using a Deltopectoral Approach With Subscapularis Splitting. Tech Hand Up Extrem Surg 2022; 26:188-192. [PMID: 35288523 DOI: 10.1097/bth.0000000000000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
Collapse
Affiliation(s)
- Georges Pfister
- Service de chirurgie orthopédique et traumatologie, Hôpital d'Instruction des Armées Percy, Henri Barbusse, Clamart, France
| | | | | | | | | | | |
Collapse
|
6
|
Dislocation Arthropathy of the Shoulder. J Clin Med 2022; 11:jcm11072019. [PMID: 35407627 PMCID: PMC8999818 DOI: 10.3390/jcm11072019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022] Open
Abstract
Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient’s age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available.
Collapse
|
7
|
Lin IH, Lin TL, Chang HW, Lin CY, Tsai CH, Lo CS, Chen HY, Chen YW, Hsu CJ. Arthroscopy-Assisted Reduction and Internal Fixation versus Open Reduction and Internal Fixation for Glenoid Fracture with Scapular Involvement: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11041131. [PMID: 35207402 PMCID: PMC8875088 DOI: 10.3390/jcm11041131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- I-Hao Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan;
| | - Hao-Wei Chang
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
| | - Chia-Yu Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
| | - Chien-Sheng Lo
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Hui-Yi Chen
- Department of Medical Image, China Medical University Hospital, Taichung 40447, Taiwan;
| | - Yi-Wen Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan;
- X-Dimension Center for Medical Research and Translation, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
| | - Chin-Jung Hsu
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
- School of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Correspondence: ; Tel.: +886-4-2205-2121
| |
Collapse
|
8
|
Oguzkaya S, van der Wijk J, van Tongel A, Beckers J, van Isacker T, Berghs B. A novel plating technique for Ideberg type 1 A glenoid fractures: a report of five patients. Shoulder Elbow 2022; 14:104-108. [PMID: 35154413 PMCID: PMC8832709 DOI: 10.1177/17585732211001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Glenoid rim fractures are uncommon and generally associated with high complication rates. The most common treatment techniques include screw or anchor fixation. Here, we introduce a new fixation method to treat Ideberg type 1 A fractures. METHODS A retrospective analysis was performed on patients treated with open reduction and plate fixation for Ideberg type 1 A fractures. The active range of motion capacity of both shoulders was recorded postoperatively. Constant-Murley score and Oxford disability index scores were used as outcome tools. RESULTS Five patients (three men and two women) were evaluated; their mean age was 56 years (standard deviation (SD), 10 years). The mean follow-up period was 25 months (range, 6-69 months); all fractures healed radiologically during the follow-up period. The mean Constant-Murley score was 80.36 (SD 11.01); the mean Oxford disability index was 37 (SD 9). The subsequent flexion and external rotation of the injured shoulders were similar to those of the uninjured side (injured vs. uninjured side: flexion, 176 ± 5.4 vs. 178 ± 4.4; external rotation, 48 ± 10.9 vs. 60 ± 0). No patient showed signs of osteoarthritis, stiffness, instability, or chronic pain at the last follow-up. DISCUSSION Open reduction and internal fixation with a plate is suitable for Ideberg type 1A glenoid fractures.
Collapse
Affiliation(s)
- Sinan Oguzkaya
- Department of Orthopaedics and Traumatology, Sarkısla State Hospital, Sivas, Turkey,Sinan Oguzkaya, Alper Tunga Cad. Kalecity evleri, B blok No: 6, Şarkışla, Sivas 58400, Turkey.
| | | | - Alexander van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Joris Beckers
- Department of Orthopaedics and Traumatology, AZ Sint Jan Hospital, Brugge, Belgium
| | - Tom van Isacker
- Department of Orthopaedics and Traumatology, AZ Sint Jan Hospital, Brugge, Belgium
| | - Bart Berghs
- Department of Orthopaedics and Traumatology, AZ Sint Jan Hospital, Brugge, Belgium
| |
Collapse
|
9
|
Königshausen M, Pätzholz S, Coulibaly M, Nicolas V, Vandemeulebroecke M, Schildhauer TA, Seybold D. Instability and results after non-operative treatment of large anterior glenoid rim fractures: is there a correlation between fragment size or displacement and recurrence? Arch Orthop Trauma Surg 2022; 142:2727-2738. [PMID: 34338888 PMCID: PMC9474463 DOI: 10.1007/s00402-021-04020-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/23/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION There 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. METHODS The 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. RESULTS N = 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. CONCLUSION Non-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 EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Matthias Königshausen
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Simon Pätzholz
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marlon Coulibaly
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Volkmar Nicolas
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marc Vandemeulebroecke
- Biostatistical Sciences and Pharmacometrics, Novartis Pharma AG, Klybeckstrasse, 4057, Basel, Switzerland
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| |
Collapse
|
10
|
Jia X, Zhou FL, Zhu YH, Jin DJ, Liu WX, Yang ZC, Liu RP. Treatment of lower part of glenoid fractures through a novel axillary approach: A case report. World J Clin Cases 2021; 9:7558-7563. [PMID: 34616826 PMCID: PMC8464446 DOI: 10.12998/wjcc.v9.i25.7558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/09/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the location and size of the fracture block, open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures. However, the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far.
CASE SUMMARY A 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident. X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture. Three-dimensional (3D) computed tomography (CT) further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm × 16.2 mm. The patient was diagnosed as the fracture of the lower part of the glenoid, also known as bony Bankart lesion without shoulder dislocation. After general anesthesia, the patient was surgically treated with the open reduction internal fixation through a novel axillary approach. 3D CT and shoulder joint function were reexamined at 12 mo of follow-up, showing acceptable recovery.
CONCLUSION This case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation. After a follow-up for more than 12 mo, 3D CT and shoulder joint function examinations display a good recovery.
Collapse
Affiliation(s)
- Xing Jia
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
- The Graduate School of Dalian Medical University, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Fu-Lin Zhou
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Yu-Hua Zhu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Dan-Jie Jin
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Wei-Xi Liu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Zhi-Cheng Yang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Rui-Ping Liu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| |
Collapse
|
11
|
Attarde D, Patil A, Kamat N, Sancheti P, Shyam A. Anterior proximal humerus fracture dislocation with concomitant glenoid fracture: An operative challenge! A case report. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211019528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Combined proximal humerus fracture dislocation and glenoid fracture is a rare combination of injuries which presents technical operative challenges. There is little evidence to guide surgical management. Case Report We report a case of a proximal humerus fracture with anterior dislocation and glenoid fracture treated in the same sitting with open reduction and internal fixation with angular stability locking plate and cannulated screw. The surgical technique involved standard deltopectoral approach with coracoid osteotomy. Conclusion By addressing both fractures operatively at the same time, we reported a satisfactory clinical and functional outcome with bony union of the fracture sites without instability at end of 1 year. Coracoid osteotomy may open an alternative pathway to treat complex proximal humerus injuries with ipsilateral glenoid fracture.
Collapse
Affiliation(s)
- Dheeraj Attarde
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Atul Patil
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Nilesh Kamat
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Parag Sancheti
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Ashok Shyam
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
- Indian Orthopaedic research group, Thane, India
| |
Collapse
|
12
|
Ernstbrunner L, Jessen M, Wieser K. Anatomic healing after non-operative treatment of a large, displaced anterior glenoid rim fracture after primary traumatic anterior shoulder dislocation – a case report. BMC Musculoskelet Disord 2020; 21:361. [PMID: 32517721 PMCID: PMC7285733 DOI: 10.1186/s12891-020-03384-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
Background Large, displaced anterior glenoid rim fractures after primary traumatic anterior shoulder dislocation are usually managed by surgical stabilization. Although there is little evidence supporting surgical management, it is often preferred over non-operative treatment. This case report describes non-operative management of such large, displaced anterior glenoid rim fracture with CT- and MRI-based documentation of anatomical healing of the fracture fragment, a finding that has not been described previously. Case presentation This case report describes a 49-year-old male, right-hand dominant, carpenter, who had a left-sided primary anterior shoulder dislocation after a fall while skiing. Initial plain radiographs showed a reduced glenohumeral joint with a large, displaced anterior glenoid rim fracture. CT-evaluation showed a centered humeral head, and as per our institutional protocol, non-operative management was initiated. Longitudinal radiographic assessment at 2 weeks, 4.5 months and 12 months showed reduction of the initially severely displaced fracture fragment. MRI- and CT-evaluation after 12 months confirmed anatomical healing of the fragment. At final follow-up, the patient was highly satisfied, although the healing process was complicated by posttraumatic frozen shoulder, which has had almost fully resolved after 12 months. Conclusions Given that the glenohumeral joint is concentrically reduced, large (displaced) anterior glenoid rim fractures after traumatic primary shoulder dislocation can be successfully treated non-operatively, with the potential of anatomical fracture fragment healing. Therefore, it remains subject to conservative treatment at our institution and surgical stabilization is reserved for patients with a decentered humeral head or persistent glenohumeral instability.
Collapse
|
13
|
Oh JC, Kim HS, Lee GH, Kang HJ. Arthroscopic treatment of a one-fourth anteroinferior glenoid comminuted fracture-dislocation with concomitant three-part complex proximal humerus fracture in a middle-aged man: a case report. Arch Orthop Trauma Surg 2020; 140:1901-1907. [PMID: 32140828 DOI: 10.1007/s00402-020-03402-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Proximal humeral fracture-dislocations can occur in high-energy traumas. This injury can be accompanied by a glenoid fracture; however, it is a rare type of complex injury in patients aged under 60 years. MATERIALS AND METHODS A 53-year-old man presented with a three-part fracture-dislocation of the proximal humerus and a severely comminuted glenoid fracture. For the glenohumeral dislocation and proximal humeral fracture, we performed closed reduction using a threaded Steinman pin and fixation with percutaneous cannulated screws. Using arthroscopy, while maintaining humeral traction with the Steinman pin, the intra-articular glenoid fragments were reduced and then fixed with a buttressing headless screw and one suture anchor. After a 6-week immobilization with a shoulder spica cast, rehabilitation was initiated. RESULTS We confirmed bony union of the fracture sites after 6 months post-surgery. The patient showed excellent clinical outcomes with a nearly full range of motion without instability CONCLUSIONS: We reported a successful outcome for a complex proximal humeral fracture involving the glenoid using closed reduction and fixation for the proximal humeral fracture and arthroscopic reduction and fixation for the comminuted anteroinferior glenoid fracture.
Collapse
Affiliation(s)
- Jin-Chul Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Hyoung-Sik Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Gi-Hoon Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| |
Collapse
|
14
|
Wieser K, Waltenspül M, Ernstbrunner L, Ammann E, Nieuwland A, Eid K, Gerber C. Nonoperative Treatment of Anterior Glenoid Rim Fractures After First-Time Traumatic Anterior Shoulder Dislocation: A Study with 9-Year Follow-up. JB JS Open Access 2020; 5:e20.00133. [PMID: 33376928 PMCID: PMC7757836 DOI: 10.2106/jbjs.oa.20.00133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary traumatic anterior shoulder dislocations can be associated with displaced anterior glenoid rim fractures. Nonoperative treatment of such fractures has been shown to have excellent results in a small cohort of patients; as such, we have been treating these fractures nonoperatively, regardless of fragment size and degree of displacement, provided that post-reduction computed tomography scans revealed an anteroposteriorly centered humeral head. The aim of this study was to analyze the medium- to long-term results of nonoperative treatment of displaced anterior glenoid rim fractures, assessing in particular the residual instability and development of osteoarthritis. METHODS In a 2-center study, 30 patients with a mean age of 48 years (range, 29 to 67 years) were evaluated clinically with use of the Subjective Shoulder Value, Constant score, American Shoulder and Elbow Surgeons score, and Western Ontario Shoulder Instability index, as well as radiographically with use of radiographs and computed tomography scans at a mean follow-up of 9 years (range, 5 to 14 years). RESULTS Fracture-healing was documented in all patients. Seven patients (23%) had post-fracture onset of osteoarthritis (5 with Samilson grade I and 2 with Samilson grade IV). Of these, 1 patient had recurrent instability that was successfully treated with hemiarthroplasty 9 years after the index injury (relative Constant score, 101%), and was excluded from further analysis. No other patient had a recurrent redislocation, subluxation, or positive apprehension. The other 6 patients with new-onset radiographic osteoarthritis were pain-free (mean Constant score pain scale, 15 points) with good shoulder function (relative Constant score, 84% to 108%). A total of 26 patients (90%) rated their functional outcome as good or very good, and 3 patients (10%) rated it as fair. The mean relative Constant score was 97% (range, 61% to 108%), the mean American Shoulder and Elbow Surgeons score was 92 points (range, 56 to 100 points), and the mean Western Ontario Shoulder Instability index score was 126 points (range, 0 to 660 points). All patients returned to full-time work. CONCLUSIONS Nonoperative treatment of anterior glenoid rim fractures following primary traumatic anterior shoulder dislocation results in excellent clinical outcomes with a very low rate of residual instability and, thus, treatment failure. Asymptomatic radiographic osteoarthritis occurred in roughly 1 of 4 patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Manuel Waltenspül
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Elias Ammann
- Department of Orthopaedics, Kantonsspital Baden, Baden, Switzerland
| | - Arend Nieuwland
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Eid
- Department of Orthopaedics, Kantonsspital Baden, Baden, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
15
|
Isolated Large Glenoid Fracture in Acute Glenohumeral Dislocation in the Elderly: A Novel Indication for Reverse Shoulder Arthroplasty. Case Rep Orthop 2020; 2020:8826803. [PMID: 32855832 PMCID: PMC7443034 DOI: 10.1155/2020/8826803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/01/2020] [Indexed: 11/17/2022] Open
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.
Collapse
|
16
|
Anatomic Reduction and Fixation for Glenoid Fractures: The Kissing Anchor Technique. Arthrosc Tech 2020; 9:e1095-e1100. [PMID: 32874888 PMCID: PMC7451734 DOI: 10.1016/j.eats.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/04/2020] [Indexed: 02/03/2023] Open
Abstract
Up to one fifth of glenoid fractures are intra-articular and associated with recurrent anterior dislocation. Surgery is often the indicated treatment, and as with many other articular fractures, it aims for a perfectly congruent and flush reconstruction of the articular surface to avoid the onset of secondary degenerative joint diseases. The purpose of this paper is to describe a reproducible, simple arthroscopic technique that uses suture anchors to fix the glenoid fragment with a strong and stable construct called "kissing anchors." This method provides the advantages of both direct and indirect stabilizing effects. It applies 2 anchors, one inside the fragment and the other inside the fracture bed, to stabilize and fix the fragment, and is adequately associated with labrum refixation, which provides the construct with increased stability. However, a surgeon willing to apply it should already be confident with basic shoulder arthroscopy and should have performed an appropriate amount of arthroscopic shoulder stabilizations.
Collapse
|
17
|
Maziak N, Minkus M, Krüger D, Scheibel M. Arthroscopic Reconstruction of Multifragmented Anteroinferior Glenoid Rim Fractures. JBJS Essent Surg Tech 2020; 9:ST-D-19-00016. [PMID: 32051775 DOI: 10.2106/jbjs.st.19.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The optimal treatment of anteroinferior glenoid rim fractures remains a matter of debate. Surgical repair aims to prevent persistent instability and osteoarthritic changes of the glenohumeral joint1-3 and is recommended in patients with a subluxated humeral head and substantial displacement of the fracture fragment(s)3-5. Arthroscopic reconstruction with suture anchors was described by Sugaya et al. for large solitary glenoid rim fractures using an indirect reduction and fixation via labral repair6. We present the arthroscopic reconstruction of a multifragmented anteroinferior glenoid rim fracture using a modified knotless anchor technique and bioabsorbable pins. The additional fixation and compression may improve reduction and consolidation of the fracture. Description The patient is placed in the lateral decubitus position with the affected arm fixed in a traction device. A standard posterior, an anterosuperior (suprabicipital), and a deep anteroinferior portal are required for this minimally invasive technique. A posterolateral portal may be required additionally. First, a diagnostic arthroscopy is performed to identify possible concomitant lesions. Labral repair enables an indirect reduction of the attached fracture fragments and is achieved by the aid of knotless suture anchors. Temporary reduction using Kirschner wires can be applied. Bioabsorbable pins can be used for additional ultimate fixation and compression of the fracture fragments. Alternatives A variety of surgical techniques for the reconstruction of glenoid rim fractures have been described in the literature, including open or arthroscopic screw osteosynthesis using either metallic or bioabsorbable screws3,6-10. Screw osteosynthesis, however, is not a feasible option for fractures with multiple small fragments3. Isolated suture anchor reconstruction represents another alternative6. Good clinical results and a high subjective satisfaction rate, however, can also be achieved by nonoperative treatment, depending on the patient and fracture characteristics3,10-12. Rationale This minimally invasive technique enables an almost anatomical reconstruction of the glenoid rim with a minor risk of hardware impingement compared with screw osteosynthesis.
Collapse
Affiliation(s)
- Nina Maziak
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus-Virchow, Berlin, Germany
| | - Marvin Minkus
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus-Virchow, Berlin, Germany
| | - David Krüger
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus-Virchow, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus-Virchow, Berlin, Germany.,Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| |
Collapse
|
18
|
Clavert P, Aim F, Bonnevialle N, Arboucalot M, Ehlinger M, Bauer T. Biomechanical properties of transosseous bony Bankart repair in a cadaver model. Orthop Traumatol Surg Res 2019; 105:271-274. [PMID: 30765309 DOI: 10.1016/j.otsr.2018.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/17/2018] [Accepted: 10/26/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We 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 METHODS Fifteen 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. RESULTS The 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/CONCLUSION This 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 EVIDENCE IV, basic science study.
Collapse
Affiliation(s)
- Philippe Clavert
- Équipe 12 matériaux multi-échelles et biomécanique, institut de mécanique des fluides et des solides, laboratoire ICube, GEBOAS, UMR 7357, CNRS UMR 7357, 2-4, rue Boussingault, 67000 Strasbourg, France; D'anatomie normale, faculté de médecine, fédération de médecine translationnelle, FMTS, 4, rue Kirschleger, 67085 Strasbourg, France; Service de chirurgie du membre supérieur, hôpitaux universitaires de Strasbourg, CCOM, avenue Baumann, 67400 Illkirch, France.
| | - Florence Aim
- Service de chirurgie orthopédique, CHU Ambroise Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France
| | - Nicolas Bonnevialle
- Département de chirurgie orthopédique, hôpital Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse, France
| | - Marine Arboucalot
- Département de chirurgie orthopédique, hôpital Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse, France
| | - Matthieu Ehlinger
- Équipe 12 matériaux multi-échelles et biomécanique, institut de mécanique des fluides et des solides, laboratoire ICube, GEBOAS, UMR 7357, CNRS UMR 7357, 2-4, rue Boussingault, 67000 Strasbourg, France; Service de chirurgie orthopédique et de traumatologie, hôpital universitaire de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
| | - Thomas Bauer
- Service de chirurgie orthopédique, CHU Ambroise Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France
| | -
- French Society for Orthopedic and Trauma Surgery, 56, rue Boissonnade, 75014 Paris, France
| |
Collapse
|
19
|
Königshausen M, Mempel E, Rausch V, Gessmann J, Schildhauer TA, Seybold D. Combined fractures of the humeral head and the glenoid. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11678-019-0508-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
20
|
Tucker A, Donnelly K, Murphy L, Ferguson G, Sloan S, Charlwood P. Percutaneous Arthroscopic-assisted Glenoid Fixation: A Novel Surgical Technique. J Orthop Case Rep 2019; 8:3-6. [PMID: 30687651 PMCID: PMC6343562 DOI: 10.13107/jocr.2250-0685.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Scapular fractures are rare injuries and are often an indicator of high-energy trauma. These injuries are rare, and many are managed without surgery. The caveat to this is intra-articular extension into the glenoid when AO Foundation principles of fracture fixation for intra-articular injuries must be adhered to. We report a percutaneous arthroscopically assisted technique for fixation of a scapular fracture with extension into the glenoid fossa in a young male patient. Case Report A 22-year-old Caucasian male presented to the emergency department after a road traffic collision. Primary assessment and secondary surgery demonstrated an isolated shoulder injury involving the glenoid. Three-dimensional imaging was performed and revealed an intra-articular glenoid fracture with the involvement of the superior suspensory apparatus of the shoulder, not fitting into known classification systems. He underwent an arthroscopically assisted percutaneous screw fixation, which resulted in reduction of the suspensory apparatus and the glenoid fossa. Conclusion Intra-articular glenoid involvement in scapular fractures mandates anatomical reduction through internal fixation. We highlight that this technique is of benefit in these injuries and is easy and quick to perform. Validated outcomes, in this case, have been excellent, with no adverse events.
Collapse
Affiliation(s)
- Adam Tucker
- Department of Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry N Ireland. BT47 6SB
| | - Kevin Donnelly
- Department of Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry N Ireland. BT47 6SB
| | - Lynn Murphy
- Department of Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry N Ireland. BT47 6SB
| | - Gary Ferguson
- Department of Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry N Ireland. BT47 6SB
| | - Sam Sloan
- Department of Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry N Ireland. BT47 6SB
| | - Phil Charlwood
- Department of Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry N Ireland. BT47 6SB
| |
Collapse
|
21
|
Bonnevialle N, Clavert P, Arboucalot M, Bahlau D, Bauer T, Ehlinger M. Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery. J Shoulder Elbow Surg 2019; 28:42-47. [PMID: 30262253 DOI: 10.1016/j.jse.2018.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Nicolas Bonnevialle
- Département d'Orthopédie Traumatologie du Centre Hospitalier Universitaire de Toulouse, Hôpital Riquet, Toulouse, France; Laboratoire de Biomécanique, Institut de Mécanique des Fluides de Toulouse- Unité Mixte de Recherche-Centre National de la Recherche Scientifique, 5502, Hôpital Riquet, Toulouse, France.
| | - Philipe Clavert
- Service de Chirurgie du Membre Supérieur, Centre de Chirurgie Orthopédique et de la Main, Illkirch, France; Laboratoire ICube, Centre National de la Recherche Scientifique Unité Mixte de Recherche 7357, Ilkirch, France
| | - Marine Arboucalot
- Département d'Orthopédie Traumatologie du Centre Hospitalier Universitaire de Toulouse, Hôpital Riquet, Toulouse, France
| | - David Bahlau
- Service de Chirurgie du Membre Supérieur, Centre de Chirurgie Orthopédique et de la Main, Illkirch, France
| | - Thomas Bauer
- Service d'Orthopédie, Ambroise Paré Hospital, Boulogne Billancourt, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital de Hautepierre, Strasbourg, France
| | -
- Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT), Paris, France
| |
Collapse
|
22
|
Corradini A, Campochiaro G, Gialdini M, Rebuzzi M, Baudi P. Arthroscopic repair of glenoid rim fractures: a ligamentotaxis surgical technique. Musculoskelet Surg 2018; 102:41-48. [PMID: 30343473 DOI: 10.1007/s12306-018-0558-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/24/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE 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. MATERIALS AND METHODS Eleven patients with IA Ideberg glenoid fracture were treated with ligamentotaxis technique. Mean age: 56 years (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 2 o'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. RESULTS After 30 months 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. CONCLUSION Acute antero-inferior glenoid rim fractures are uncommon but they are increasing in over 55 years 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.
Collapse
Affiliation(s)
- A Corradini
- Ospedale Santa Maria Bianca, Mirandola, Modena, Italy.
| | | | - M Gialdini
- Azienda Ospedaliero-Universitara Policlinico di Modena, Modena, Italy
| | - M Rebuzzi
- Arcispedale Santa Maria Nova, Reggio Emilia, Reggio Emilia, Italy
| | - P Baudi
- Ospedale di Suzzara, Suzzara, Mantova, Italy
| |
Collapse
|
23
|
Gerhardt C, Lehmann LJ. [Arthroscopic fracture treatment of the shoulder joint]. DER ORTHOPADE 2018; 47:148-157. [PMID: 29318329 DOI: 10.1007/s00132-017-3512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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 a minimally 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.
Collapse
Affiliation(s)
- C Gerhardt
- Klinik für Unfall- und Handchirurgie, ViDia Christliche Kliniken Karlsruhe, St. Vincentius-Kliniken, Südendstr. 32, 76135, Karlsruhe, Deutschland.
| | - L J Lehmann
- Klinik für Unfall- und Handchirurgie, ViDia Christliche Kliniken Karlsruhe, St. Vincentius-Kliniken, Südendstr. 32, 76135, Karlsruhe, Deutschland
| |
Collapse
|
24
|
Rausch V, Königshausen M, Geßmann J, Schildhauer TA, Seybold D. [Bony Bankart lesions and glenoid defects : From refixation techniques to bony augmentation]. Unfallchirurg 2017; 121:117-125. [PMID: 29127438 DOI: 10.1007/s00113-017-0434-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rim defects of the anterior glenoid cavity are a main reason for residual shoulder instability after traumatic dislocation of the shoulder. These defects can be the result of a glenoid 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.
Collapse
Affiliation(s)
- V Rausch
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - M Königshausen
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - J Geßmann
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - T A Schildhauer
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - D Seybold
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| |
Collapse
|
25
|
The "triple dislocation fracture": anterior shoulder dislocation with concomitant fracture of the glenoid rim, greater tuberosity and coracoid process-a series of six cases. J Shoulder Elbow Surg 2017; 26:e278-e285. [PMID: 28372969 DOI: 10.1016/j.jse.2017.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND A combined fracture of the glenoid rim, greater tuberosity, and coracoid process after anterior shoulder dislocation is a rare event. Only 1 patient has been reported in the literature. METHODS All patients with a first-time traumatic anterior shoulder dislocation in a level A trauma center were retrospectively reviewed. Among the 2068 patients treated between 1998 and 2013, we identified 6 patients (0.3%; 1 female, 5 male) with "triple dislocation fracture" (anterior shoulder dislocation with concomitant fracture of the glenoid rim, greater tuberosity, and coracoid process). All patients underwent surgery and had computed tomography scans before surgery and the first postoperative day. Mean follow-up time was 59 months. Clinical and radiographic evaluation, Constant-Murley Score, Simple Shoulder Test, and Subjective Shoulder Value were performed at the final follow-up. RESULTS Surgery was determined individually according to the radiologic findings, patient's age, and personal demands. Glenoid reconstruction was performed in all 6 patients, greater tuberosity refixation in 4 patients, and coracoid process refixation in 3. Two patients needed revision surgery due to loss of reduction. At the final follow-up, mean abduction was 133°, mean anterior flexion was 138°; the mean Constant-Murley Score was 72 points; the mean Simple Shoulder Test was 9 points; and the mean Subjective Shoulder Value was 72%. No recurrent instability occurred. CONCLUSIONS A "triple dislocation fracture," especially coracoid process fractures, can easily be overlooked in radiographs. Computed tomography scans are strongly recommended in patients with a first-time traumatic shoulder dislocation. Because recurrent joint instability and secondary arthropathy are serious complications after anterior shoulder dislocation, surgery should be considered and provides satisfying to excellent results.
Collapse
|
26
|
Abstract
The glenoid fossa is involved in approximately 10% of all scapular fractures.Glenoid fossa incongruity is surprisingly well tolerated.Surgery is recommended when 20% or more of the anterior glenoid fossa is involved.Glenoid rim fractures often lead to chronic shoulder instability.Unstable glenoid neck fractures need surgical treatment and stable fractures can be treated conservatively.CT examination with 3D reformations of the glenoid fossa has improved insight into fracture morphology and fracture patterns and is very helpful for clinical decision makers. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160082. Originally published online at www.efortopenreviews.org.
Collapse
Affiliation(s)
- Lars Henrik Frich
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - Morten Schultz Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| |
Collapse
|
27
|
Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2017; 1:325-331. [PMID: 28461964 PMCID: PMC5367527 DOI: 10.1302/2058-5241.1.160016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness. Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term. In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle. The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications. ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues. Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time. The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs.
Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
Collapse
Affiliation(s)
- Luca Dei Giudici
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Faini
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Garro
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Agostino Tucciarone
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
28
|
Zbili D, Sali E, Serane J, Lefèvre E, Amsallem L. Arthroscopy-Assisted Reduction and Fixation of a Transversal Glenoid Fracture: About a Case. Case Rep Orthop 2017; 2017:2816216. [PMID: 28386498 PMCID: PMC5366194 DOI: 10.1155/2017/2816216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/09/2017] [Indexed: 11/18/2022] Open
Abstract
An articular glenoid fracture is an uncommon injury. Usually significantly displaced intra-articular glenoid fractures are treated with open reduction surgery. Conventional open surgery techniques involve high morbidity. Here we describe an arthroscopy-assisted reduction and fixation method of an Ideberg type III glenoid fracture. This method provides good articular reduction without extensive exposure or soft tissue dissection and without nerve and/or vascular lesion.
Collapse
Affiliation(s)
- David Zbili
- Service d'Orthopédie & Traumatologie, Hôpital Beaujon, 100 Boulevard du Géneral Leclerc, 92110 Clichy, France
| | - Eric Sali
- Service d'Orthopédie & Traumatologie, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Julien Serane
- Service d'Orthopédie & Traumatologie, Hôpital Beaujon, 100 Boulevard du Géneral Leclerc, 92110 Clichy, France
| | - Edouard Lefèvre
- Service d'Orthopédie & Traumatologie, Hôpital Beaujon, 100 Boulevard du Géneral Leclerc, 92110 Clichy, France
| | - Lior Amsallem
- Service d'Orthopédie & Traumatologie, Hôpital Beaujon, 100 Boulevard du Géneral Leclerc, 92110 Clichy, France
| |
Collapse
|
29
|
Moroder P, Haniel F, Quirchmayr M, Schulz E, Eppel M, Matis N, Auffarth A, Resch H. Effect of glenoid concavity loss on shoulder stability- a case report in a professional wrestler. BMC Musculoskelet Disord 2016; 17:357. [PMID: 27549093 PMCID: PMC4994269 DOI: 10.1186/s12891-016-1210-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background Current glenoid defect measurement techniques only quantify bone loss in terms of defect diameter or surface. However, the glenoid depth plays an important role in shoulder stabilization by means of concavity compression. Case presentation We present a case of a professional wrestler who suffered from anterior shoulder instability after sustaining a bony Bankart lesion without loss of glenoid surface area but flattening of the concavity due to medialization of the fragment. The patient’s glenoid concavity was reconstructed arthroscopically by reduction and percutaneous screw fixation of the bony fragment along with a capsulo-ligamentous shift. Changes of the glenoid concavity with according alterations in the Bony Shoulder Stability Ratio (BSSR) were analyzed on pre-op, post-op, and follow-up CT scans. Postoperative CT scans revealed a deepened concavity (3.3 mm) and improved BSSR (46.1 %) compared to pre-op scans (0.7 mm; 11.3 %). Follow-up CT scans showed a slight remodeling of the glenoid concavity (3.2 mm) with steady BSSR (44.7 %). Conclusion This case shows that the passive stabilizing effect of the glenoid can be compromised by loss of concavity despite the absence of loss of articular surface. Therefore, addressing the concavity loss and resulting reduction of the BSSR is recommended in these cases. Bony Bankart repair was successful in restoring the BSSR of the patients shoulder as determined by mathematical calculations based on CT scans.
Collapse
Affiliation(s)
- Philipp Moroder
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria. .,Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
| | - Franziska Haniel
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Michael Quirchmayr
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Eva Schulz
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Manfred Eppel
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Nicholas Matis
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Alexander Auffarth
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Herbert Resch
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| |
Collapse
|
30
|
Arthroscopic reduction and fixation of large solitary and multifragmented anterior glenoid rim fractures. J Shoulder Elbow Surg 2016; 25:781-90. [PMID: 26652699 DOI: 10.1016/j.jse.2015.09.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment of large anterior glenoid rim fractures is still a matter of debate. The purpose of this study was to evaluate the clinical and radiologic results of an arthroscopic reduction and fixation of acute displaced large solitary or multifragmented anterior glenoid rim fractures using anchors or bioabsorbable compression screws. METHODS Twenty-three consecutive patients (7 women, 16 men; mean age, 47.9 [15-74] years) were treated. The patients were followed up clinically (range of motion, instability testing, and shoulder outcome scores) and with conventional radiographs (true anterior-posterior, axillary, and Bernageau views). RESULTS With a minimum follow-up of 24 months, 21 patients could be evaluated. The average Constant score was 84.5 points, the Rowe score was 90.8 points, the Melbourne Instability Shoulder Score was 96.2 points, the Western Ontario Shoulder Instability Index was 89.2%, and the subjective shoulder value averaged 92.1%. No patient had suffered recurrent instability. The radiologic evaluation revealed signs of osteoarthritis in 7 cases, which was pre-existing in 1 patient. Patients with osteoarthritis were on average 10 years older at the time of surgery compared with patients without osteoarthritis. A postoperative step-off of the glenoid was detected in 7 cases and averaged 2 (1-3) mm. We could not find a correlation between the step-off and the presence of osteoarthritis. CONCLUSION Arthroscopic reconstruction of acute large solitary and multifragmented fractures of the glenoid rim shows good and excellent clinical results. In the majority of cases, an anatomic reduction and healing of the glenoid fracture can be achieved. The rate of osteoarthritis needs further investigation.
Collapse
|
31
|
Pathoanatomy and computed tomography classification of glenoid fossa fractures based on ninety patients. INTERNATIONAL ORTHOPAEDICS 2016; 40:2383-2392. [PMID: 27026622 DOI: 10.1007/s00264-016-3169-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the article is to present the pathoanatomy and a new classification of glenoid fractures developed on the basis of analysis of 3D computed tomography (CT) examinations and intra-operative findings. MATERIALS AND METHODS The study group comprised 90 patients (69 men and 21 women) who sustained glenoid fractures. Mean patient age was 47 years (17-92). In 77 nonpolytraumatised patients, anteroposterior (AP) radiographs of the affected shoulder girdle were taken, including Neer I and II views. All 90 patients underwent CT examination, combined in 73 of them with 3D CT reconstruction including subtraction of the humeral head, ribs and clavicle, from the anterior and posterolateral views. In total, 52 patients (58 %) were operated on and 38 42 %) were treated non-operatively. RESULTS In total, five basic types of injuries to the glenoid were identified based on analysis of the separated portion of the glenoid fossa: including fractures of the superior glenoid (14 cases, 16 %), the anterior glenoid (23 cases, 23 %), the posterior rim of the glenoid (5 cases, 6 %), the inferior glenoid (38 cases, 42 %) and the entire glenoid (10 cases, 11 %). CONCLUSION The proposed classification of glenoid fractures defines five basic types of fractures verified by 3D CT reconstructions and intra-operative findings. It respects the anatomical architecture of scapula, fracture mechanism, associated injuries to the shoulder girdle and, where appropriate, the preferred surgical approach.
Collapse
|
32
|
Einflussfaktoren und Komplikationen bei offener Versorgung akuter anteriorer Glenoidrandfrakturen. Unfallchirurg 2016; 120:320-328. [DOI: 10.1007/s00113-015-0129-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
|
33
|
Knöcherne Glenoidverletzungen. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0036-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
34
|
Glenohumerale Luxation. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
35
|
Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports. Arthroscopy 2015; 31:1472-81. [PMID: 25911390 DOI: 10.1016/j.arthro.2015.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/10/2015] [Accepted: 03/05/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions. METHODS The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis. RESULTS From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P = .005), level (P = .02), and risk category (P = .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P = .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients. CONCLUSIONS Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non-shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
|
36
|
Imaging methods for quantifying glenoid and Hill-Sachs bone loss in traumatic instability of the shoulder: a scoping review. BMC Musculoskelet Disord 2015; 16:164. [PMID: 26187270 PMCID: PMC4506419 DOI: 10.1186/s12891-015-0607-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/28/2015] [Indexed: 01/01/2023] Open
Abstract
Background Glenohumeral instability is a common problem following traumatic anterior shoulder dislocation. Two major risk factors of recurrent instability are glenoid and Hill-Sachs bone loss. Higher failure rates of arthroscopic Bankart repairs are associated with larger degrees of bone loss; therefore it is important to accurately and reliably quantify glenohumeral bone loss pre-operatively. This may be done with radiography, CT, or MRI; however no gold standard modality or method has been determined. A scoping review of the literature was performed to identify imaging methods for quantifying glenohumeral bone loss. Methods The scoping review was systematic in approach using a comprehensive search strategy and standardized study selection and evaluation. MEDLINE, EMBASE, Scopus, and Web of Science were searched. Initial selection included articles from January 2000 until July 2013, and was based on the review of titles and abstracts. Articles were carried forward if either reviewer thought that the study was appropriate. Final study selection was based on full text review based on pre-specified criteria. Consensus was reached for final article inclusion through discussion amongst the investigators. One reviewer extracted data while a second reviewer independently assessed data extraction for discrepancies. Results Forty-one studies evaluating glenoid and/or Hill-Sachs bone loss were included: 32 studies evaluated glenoid bone loss while 11 studies evaluated humeral head bone loss. Radiography was useful as a screening tool but not to quantify glenoid bone loss. CT was most accurate but necessitates radiation exposure. The Pico Method and Glenoid Index method were the most accurate and reliable methods for quantifying glenoid bone loss, particularly when using three-dimensional CT (3DCT). Radiography and CT have been used to quantify Hill-Sachs bone loss, but have not been studied as extensively as glenoid bone loss. Conclusions Radiography can be used for screening patients for significant glenoid bone loss. CT imaging, using the Glenoid Index or Pico Method, has good evidence for accurate quantification of glenoid bone loss. There is limited evidence to guide imaging of Hill-Sachs bone loss. As a consensus has not been reached, further study will help to clarify the best imaging modality and method for quantifying glenohumeral bone loss. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0607-1) contains supplementary material, which is available to authorized users.
Collapse
|
37
|
|
38
|
Kim YS, Lee BG, Rhee YG, Lee CH. Arthroscopic reduction and internal fixation for displaced anterior glenoid rim and greater tuberosity fractures. J Orthop Sci 2014; 19:497-501. [PMID: 23001128 DOI: 10.1007/s00776-012-0309-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/24/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Yee-Suk Kim
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | | | | | | |
Collapse
|
39
|
Krüger D, Kraus N, Gerhardt C, Scheibel M. Technik und Grenzen arthroskopischer Versorgung von Glenoid- und Skapulafrakturen. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s11678-013-0215-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
40
|
Arthroscopic bony bankart repair using double-threaded headless screw: a case report. Case Rep Orthop 2012; 2012:789418. [PMID: 23227392 PMCID: PMC3505899 DOI: 10.1155/2012/789418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/02/2012] [Indexed: 11/18/2022] Open
Abstract
We present a case of arthroscopic fixation for bony Bankart lesion using a double-threaded cannulated screw. A 39-year-old man sustained a left shoulder injury from a motorcycle accident. Radiographs showed bony Bankart lesion and CT revealed 40% defect of glenoid articular surface. Arthroscopic fixation was performed using double-threaded cannulated screw after the bony fragment was reduced by suturing the labrum at the edge with a suture anchor. Arthroscopic bony Bankart repair using double-threaded cannulated screw fixation is effective because compression force could be applied between bony fragments and the screw head is not exposed in the glenohumeral joint.
Collapse
|
41
|
Kim HS, Koh IH, Kim SG, Chun YM, Kim SJ, Kang HJ. Treatment of Anterior Glenoid Rim Fracture with Comminuted Fragment Using Arthroscopic Reduction and AO Headless Compression Screw Fixation - A Case Report -. Clin Shoulder Elb 2011. [DOI: 10.5397/cise.2011.14.1.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
42
|
Marsland D, Ahmed HA. Arthroscopically assisted fixation of glenoid fractures: a cadaver study to show potential applications of percutaneous screw insertion and anatomic risks. J Shoulder Elbow Surg 2011; 20:481-90. [PMID: 21106402 DOI: 10.1016/j.jse.2010.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 07/23/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Displaced glenoid fractures require reduction and internal fixation to avoid chronic instability or degenerative changes. Arthroscopically assisted percutaneous fixation has been performed successfully for such fractures, avoiding extensive surgical dissection. To assess the application of this new technique, our cadaveric study was designed to show 1) the safe zones of percutaneous screw insertion and 2) the position of bony obstructions to the glenoid. METHODS In 18 cadaver shoulders, we performed arthroscopically assisted percutaneous wire insertion into the glenoid using anterior, superior, and posterior approaches. After dissection, distances from wires to the relevant neurovascular structures were recorded, and 95% confidence intervals were calculated. A safe distance was defined as 15 mm. The entry point of each wire and angle of insertion relative to the glenoid clock face was also recorded. RESULTS Superior and posterior percutaneous approaches appear to be safe, with minimal risk to the suprascapular vessels and axillary nerve, respectively. The anterior approach injured the cephalic vein in 30% of specimens, and there was a clinically significant risk to the musculocutaneous nerve and inferior branch of the suprascapular nerve. The superior portion of the glenoid is accessible by percutaneous screw insertion between the clock times 7:40 and 2:50, apart from positions occupied by the coracoid (1:05-2:00) and acromion (9:35-10:55). CONCLUSIONS Arthroscopic fixation of complex glenoid fractures has had good outcomes in clinical case studies. This cadaveric study shows that percutaneous screw insertion is safe via superior and posterior approaches and feasible for a range of fracture configurations.
Collapse
Affiliation(s)
- Daniel Marsland
- International Center for Orthopaedic Advancement, The Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA.
| | | |
Collapse
|
43
|
Arthroscopy-assisted fracture fixation. Knee Surg Sports Traumatol Arthrosc 2011; 19:320-9. [PMID: 21082166 DOI: 10.1007/s00167-010-1298-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 10/12/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE the purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. METHODS published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. RESULTS arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. CONCLUSION arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures.
Collapse
|
44
|
Abstract
The adequate treatment of antero-inferior glenoid rim fractures is a controversial issue. Marginal knowledge exists about the results of non-operative treatment. Therefore, the aim of this study was to evaluate the results of conservative treatment of acute fragment type lesions (type Ib) of the antero-inferior glenoid.A total of 10 patients (5 female and 5 male, mean age 56.5 years) were included in this retrospective study. A complete clinical examination of the shoulders and four functional scores, the Constant Score (CS), Rowe Score (RS), Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) as well as a radiologic evaluation using true a/p and axillary radiographs were performed.After a mean follow-up of 26.4 months no clinical signs of subjective instability or redislocation were found. The median CS reached 80.5 points (range 52-88) versus 84 points (range 73-90) on the healthy contralateral side (p >0.05). The RS, WOSI and SSV achieved 95 points (range 70-100), 86.7% (range 51-99.6%) and 85 % (range 50-100%), respectively. The radiologic evaluation showed a consolidated fragment in all patients. The anterior subchondral sclerosis zone was reformed completely in seven patients. The mean intra-articular step-off was 2 mm (range 0-6 mm). Osteoarthritis was seen in two cases (one grade I and one grade II according to Samilson and Prieto) none of which was symptomatic and the one grade II was present at the time of trauma.The conservative treatment of acute fragment type lesions (type Ib) of the antero-inferior glenoid can lead to excellent and satisfactory clinical results and therefore represents a suitable treatment alternative in the middle aged patient population. Nevertheless, future studies have to explicitly define the exact indications for a conservative versus surgical treatment approach.
Collapse
|
45
|
|
46
|
Arthroscopic reduction and cannulated screw fixation of a large anterior glenoid rim fracture. J Shoulder Elbow Surg 2010; 19:e16-9. [PMID: 20189417 DOI: 10.1016/j.jse.2009.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 11/06/2009] [Accepted: 11/08/2009] [Indexed: 02/01/2023]
|
47
|
Pujol N, Fong O, Scharycki S, Remi J, Beaufils P, Boisrenoult P. Simultaneous arthroscopic treatment of displaced greater tuberosity and glenoid fracture using a double-row technique. Knee Surg Sports Traumatol Arthrosc 2009; 17:1508-10. [PMID: 19629440 DOI: 10.1007/s00167-009-0873-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 06/29/2009] [Indexed: 11/28/2022]
Abstract
A rare case with concomitant fracture of the greater tuberosity and a bony Bankart lesion is described. Bioabsorbable suture anchors are used to reduce and fix both fractures utilizing a double-row suture-bridge technique. First, the Bankart fracture is reduced, and then the greater tuberosity fracture is reduced through a subacromial approach. This arthroscopic technique provides a firm 3-point fixation for both fractures that is minimally invasive.
Collapse
Affiliation(s)
- Nicolas Pujol
- Orthopedic Department, Hôpital André Mignot, 177, rue de Versailles, 78157 Le Chesnay, France.
| | | | | | | | | | | |
Collapse
|
48
|
Osti M, Gohm A, Benedetto KP. Results of open reconstruction of anterior glenoid rim fractures following shoulder dislocation. Arch Orthop Trauma Surg 2009; 129:1245-9. [PMID: 19221773 DOI: 10.1007/s00402-009-0828-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The present study evaluates the clinical and radiological outcome following open reconstruction of avulsion fractures of the anterior glenoid rim in traumatic shoulder dislocation. MATERIAL AND METHODS A total of 20 patients (mean age 49.4 years) were treated with open reduction and cannulated screw fixation. Eighteen patients were available for clinical and radiological follow-up after 3.1 (2.0-6.5) years. RESULTS The average Constant Score was 78 and the average Rowe Score was 90 points. Documented complications were implant failure in one and neurological dysfunction in one patient. Radiographs revealed the bony fragment located in an unimproved displaced position in one patient and a progress in osteoarthritic changes in three patients. No recurrent subluxation or dislocation was observed. CONCLUSION Open reconstruction of glenoid rim fractures is a valuable procedure regarding medium-term subjective and objective outcome measures. Recurrent dislocation, glenoid defects and early onset of osteoarthritic degeneration can be avoided.
Collapse
Affiliation(s)
- Michael Osti
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
| | | | | |
Collapse
|
49
|
Abstract
Bony instability of the shoulder due to glenoid defects has recently received increasing attention. Glenoid defects can be divided into acute fragment-type lesions (type I), chronic fragment-type lesions (type II) and glenoid bone loss without a bony fragment (type III). The diagnosis and classification are mainly based on imaging methods including a radiographic instability series and/or computed tomography. The management of anterior glenoid rim lesions depends on many factors including the clinical presentation, type of lesion, concomitant pathology as well as age and functional demands of the patient. If bony-mediated instability is present, surgery is indicated. In the majority of cases fragment-type lesions can be successfully treated using either arthroscopic or open reconstruction techniques.Small erosion-type lesions can also be managed via soft-tissue procedures, whereas large erosion-type lesions with significant bone loss may necessitate bone-grafting procedures (autologous iliac crest or coracoid transfer) to restore glenoid concavity and shoulder stability. Although glenoid bone grafting is usually performed via an open approach, recent clinical studies have shown that it can be successfully managed by advanced arthroscopic techniques.
Collapse
|
50
|
Sano T, Matsuoka H, Nakayama K. Arthroscopic treatment of an anterior glenoid fracture with a cannulated, headless screw and suture anchors: a case report. Knee Surg Sports Traumatol Arthrosc 2009; 17:539-41. [PMID: 19252898 DOI: 10.1007/s00167-009-0732-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 01/20/2009] [Indexed: 11/28/2022]
Abstract
Recently, anterior glenoid fractures have been treated arthroscopically with either suture anchors or screws. The keys to this arthroscopic procedure are to repair the labrum and to firmly fix the osseous fragment. We used suture anchors to repair the labrum and reduce the osseous fragment, and a cannulated headless screw to fix the osseous fragment. This is the first case report of arthroscopic treatment of an anterior glenoid fracture using suture anchors and a cannulated headless screw.
Collapse
Affiliation(s)
- Teiichi Sano
- Department of Orthopaedics, Shizuoka General Hospital, Aoi, Shizuoka, Japan.
| | | | | |
Collapse
|