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

Abstract

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