Journal of Orthopedics and Joint Surgery

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VOLUME 6 , ISSUE 1 ( January-June, 2024 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Intra-articular Glenoid Fracture Managed by Arthroscopic Fixation and Open Reduction and Internal Fixation Techniques: An Analytical Study

Prahalad Kumar Singhi, Sivakumar Raju, Chidambaram Muthu, Gopi Kumarasamy, Vinoth Thangamani, MuthuKishore Marichamy

Keywords : Arthroscopic fixation, Intra-articular glenoid fracture, Open reduction and internal fixation, Treatment algorithm

Citation Information : Singhi PK, Raju S, Muthu C, Kumarasamy G, Thangamani V, Marichamy M. Intra-articular Glenoid Fracture Managed by Arthroscopic Fixation and Open Reduction and Internal Fixation Techniques: An Analytical Study. 2024; 6 (1):20-26.

DOI: 10.5005/jojs-10079-1129

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Intra-articular glenoid fractures are rare injuries. Due to complex anatomy and neurovascular structures in vicinity, operative treatment is relatively uncommon. With the advent of three-dimensional (3D) computed tomography (CT), appropriate analysis of fracture pattern and management protocols can be developed. Operative treatment has evolved from extensive open reduction to arthroscopic surgery. Here, we analyzed the intra-articular glenoid fractures, which were managed by conservative, open, or arthroscopic fixation (ARIF) to derive a treatment algorithm. Materials and methods: All the shoulder fractures which presented to our hospital from January 2018 to December 2020 were screened for intra-articular glenoid fractures. An institutional treatment algorithm was followed for 10 such fractures, where four underwent ARIF, four by open reduction, and two were conserved. These patients were followed up, and functional evaluation with Constant–Murley and the University of California, Los Angeles (UCLA) scoring system were done. Results and discussion: The mean constant score at 1 and 2 years follow-up were 63.2 ± 9.3 and 78 ± 9.7, respectively. The mean UCLA score at 1 and 2 years follow-up were 23.7 ± 4.4 and 28.3 ± 3.7, respectively. At the end of 2 years’ follow-up, all these patients had good to excellent outcome. One patient had shoulder stiffness; clavicle elastic nail was removed in two cases as it caused irritation at entry site and no other major complications. Conclusion: Intra-articular glenoid fractures are uncommon injuries but can end up in severe morbidity if neglected or not aptly treated. Anatomical restoration of the articular surface is the goal in management of intra-articular glenoid fractures. Undisplaced fractures or articular step-off <2 mm can be managed conservatively. Even the undisplaced glenoid fracture needs fixation if there is a double disruption of scapulothoracic suspensory complex (SSSC). Displaced intra-articular fractures without extending into scapular body and double disruption of SSSC can be managed with ARIF. Intra-articular glenoid fracture extending to scapular body or double disruption of SSSC warrants open surgery. Clinical significance: We report a single-center study with treatment algorithm for surgical management and decision-making in intra-articular glenoid fractures, which remains challenging.


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  1. Jaeger M, Lambert S, Südkamp NP, et al. The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on glenoid fossa involvement. J Shoulder Elbow Surg 2013;22(4):512–520. DOI: 10.1016/j.jse.2012.08.003
  2. Armitage BM, Wijdicks CA, Tarkin IS, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am 2009;91(9):2222–2228. DOI: 10.2106/JBJS.H.00881
  3. Maquieira GJ, Espinosa N, Gerber C, et al. Non-operative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder. J Bone Joint Surg Br 2007;89(10):1347–1351. DOI: 10.1302/0301-620X.89B10.19273
  4. Seidl AJ, Joyce CD. Acute fractures of the glenoid. J Am Acad Orthop Surg 2020;28(22):e978–e987. DOI: 10.5435/JAAOS-D-20-00252
  5. Frich LH, Larsen MS. How to deal with a glenoid fracture. EFORT Open Rev 2017;2(5):151–157. DOI: 10.1302/2058-5241.2.160082
  6. Tauber M, Moursy M, Eppel M, et al. Arthroscopic screw fixation of large anterior glenoid fractures. Knee Surg Sports Traumatol Arthrosc 2008;16(3):326–332. DOI: 10.1007/s00167-007-0437-2
  7. Scheibel M, Magosch P, Lichtenberg S, et al. Open reconstruction of anterior glenoid rim fractures. Knee Surg Sports Traumatol Arthrosc 2004;12(6):568–573. DOI: 10.1007/s00167-004-0495-7
  8. Ideberg R. Fractures of the scapula involving the glenoid fossa. Surg Shoulder 1984.
  9. Manohara R, Kumar VP. A Reverse Judet approach to the scapula. Arch Orthop Trauma Surg 2018;138(5):669–673. DOI: 10.1007/s00402-018-2897-x
  10. Obremskey WT, Lyman JR. A modified Judet approach to the scapula. J Orthop Trauma 2004;18(10):696–699. DOI: 10.1097/00005131-200411000-00007
  11. Brodsky JW, Tullos HS, Gartsman GM. Simplified posterior approach to the shoulder joint. A technical note. J Bone Joint Surg Am 1987;69(5):773–774. DOI: 10.2106/00004623-198769050-00021
  12. Constant CR. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br 1997;79(4):695–696. DOI: 10.1302/0301-620x.79b4.0790695c
  13. Romeo AA, Bach BR Jr, O'Halloran KL. Scoring systems for shoulder conditions. Am J Sports Med 1996;24(4):472–476. DOI: 10.1177/036354659602400411
  14. Cole PA, Schroder LK. Scapula fractures. Evidence-Based Orthopedics 2021. pp. 457–461.
  15. Anavian J, Gauger EM, Schroder LK, et al. Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures. J Bone Joint Surg Am 2012;94(7):645–653. DOI: 10.2106/JBJS.J.00896
  16. Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Joint Surg Br 1984;66(5):725–731. DOI: 10.1302/0301-620X.66B5.6501369
  17. Kavanagh BF, Bradway JK, Cofield RH. Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa. J Bone Joint Surg Br 1993;75(4):479–484. DOI: 10.2106/00004623-199304000-00001
  18. Leung KS, Lam TP, Poon KM. Operative treatment of displaced intra-articular glenoid fractures. Injury 1993;24(5):324–328. DOI: 10.1016/0020-1383(93)90056-c
  19. Adam FF. Surgical treatment of displaced fractures of the glenoid cavity. Int Orthop 2002;26(3):150–153. DOI: 10.1007/s00264-002-0342-8
  20. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res 1998;347:122–130. DOI: 10.1097/00003086-199802000-00015
  21. Schandelmaier P, Blauth M, Schneider C, et al. Fractures of the glenoid treated by operation. A 5- to 23-year follow-up of 22 cases. J Bone Joint Surg Br 2002;84(2):173–177. DOI: 10.1302/0301-620x.84b2.12357
  22. Bauer T, Abadie O, Hardy P. Arthroscopic treatment of glenoid fractures. Arthroscopy 2006;22(5):569.e1–569.e6. DOI: 10.1016/j.arthro.2006.01.003
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