Combined fractures of the humeral head and the glenoid

Königshausen, Matthias; Mempel, Eileen; Rausch, Valentin; Geßmann, Jan; Schildhauer, Thomas; Seybold, D.

doi:10.1007/s11678-019-0508-2

Cited by 6 publications

(4 citation statements)

References 52 publications

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“…Rarely, proximal humerus fractures are associated with glenoid fractures. This combination may be indicative of an instability event at the time of injury and is often treated surgically [ 7 ], especially when the glenoid fragment is displaced. Although there is no universal consensus for the surgical indications to stabilise these fractures, Königshausen et al have proposed that surgery is indicated when the glenoid fragment presents with a medial displacement of more than 3 mm and/or a fracture gap of more than 5 mm [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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A Unique Presentation of the Glenoid, Coracoid, and Proximal Humerus Fractures

Assiotis¹,

Uppal²,

Rumian³

et al. 2023

Cureus

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Fractures of the proximal humerus are common injuries with a bimodal age distribution. They usually present in younger patients after high-energy trauma and in elderly patients after lower-energy trauma. Fractures of the proximal humerus are rarely associated with concomitant fractures of the glenoid, and this is a complex injury pattern that indicates the presence of significant instability. Such injuries are usually treated surgically. Even more rarely, patients may present with proximal humerus fractures and fractures of the coracoid process. A male patient presented to our emergency department (ED) after a fall off the loading platform of his heavy goods vehicle (HGV), resulting in a right shoulder injury. During his initial assessment in ED, a computerised tomography (CT) scan demonstrated the presence of a comminuted proximal humerus fracture, a comminuted anterior glenoid wall fracture, and a coracoid process displaced fracture. Surgical fixation of all three fractures was undertaken in the same sitting. This is the first case described in the literature with a combination of the above injuries and serves as a reminder that as trauma complexity and incidence continue to increase, we should maintain a high index of diagnostic suspicion when dealing with such patients. Furthermore, we present our treatment approach for this case and the rationale behind it.

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Section: Discussionmentioning

confidence: 99%

“…Glenohumeral combination fractures were described as an entity and classified by Könignhausen et al [ 7 ], who described four possible types. Type 1b describes a large glenoid rim fracture, a greater tuberosity fracture, and an additional coracoid process fracture.…”

Section: Discussionmentioning

confidence: 99%

A Unique Presentation of the Glenoid, Coracoid, and Proximal Humerus Fractures

Assiotis¹,

Uppal²,

Rumian³

et al. 2023

Cureus

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“…fractures into groups according to the severity of each fracture, and suggested a treatment algorithm for these injuries, predominantly surgical treatment 18 . Our cohort of patients would correspond to their classification of Type 2 glenohumeral combination fractures, describing them as large anterior glenoid rim fracture and proximal humeral fracture.…”

Section: Königshausen Et Al Classified Glenohumeral Combinationmentioning

confidence: 99%

The ‘Floating Humeral Head’, A Case Series of Combined Proximal Humeral and Glenoid Fracture Dislocations

Ong¹,

Awadallah²,

White³

et al. 2020

J Orthopedics & Orthopedic Surg

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Background: Fracture of the proximal humerus combined with dislocation of the glenohumeral joint and a soft tissue or bony Bankart lesion are rare. Management options are largely surgical and different approaches to fixation have been described. The reported outcomes are generally poor. Methods: We present a series of three rare cases of traumatic dislocations of the shoulder associated with combined fractures of the proximal humerus and glenoid that were treated with surgical fixation. We describe the surgical technique and clinical outcomes. Results: Our patients had multiple medical comorbidities; and coupled with the burden of injury, made a slow post-operative recovery (mean Constant-Murley score of 48 points over a mean follow-up time of 20 months). Conclusion: A high index of suspicion and appropriate imaging is required to properly diagnose and surgically manage this uncommon pattern of injury. We recommend surgical treatment of these severe injuries, to stabilise the glenohumeral joint, and to achieve optimal clinical outcomes.

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“…Anterior shoulder instability is frequently associated with glenoid bone loss. 9,14,20,25 If the glenoid bone loss exceeds a certain amount, soft tissue stabilization surgery often does not provide sufficient stability. 9 The cutoff value for critical glenoid bone loss that necessitates surgical treatment remains a subject of debate.…”

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confidence: 99%

The Biomechanical Effect of Bone Grafting and Bone Graft Remodeling in Patients With Anterior Shoulder Instability

et al. 2020

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Background: Individual constitutional differences in glenoid shape and bone remodeling require a patient-specific and longitudinal approach to evaluate the biomechanical effects of glenoid bone grafting in patients with anterior shoulder instability. Purpose: To quantify the longitudinal, in vivo, biomechanical effects of bone grafting, bone graft remodeling, and glenoid shape in patients with anterior shoulder instability by means of patient-specific finite element models. Study Design: Descriptive laboratory study. Methods: In total, 25 shoulders of 24 patients with anterior shoulder instability and anterior glenoid bone loss underwent an arthroscopic iliac crest bone graft transfer (ICBGT) procedure with either autologous or allogenic bone. Patient-specific finite element simulations based on preoperative, postoperative, and follow-up computed tomography scans were used to quantify the bone-mediated stability ratio (SR) and the distance to dislocation. Additionally, the relationship between glenoid morphological parameters and the SR was assessed. Results: The ICBGT procedure significantly increased the SR and distance to dislocation in the 2-, 3-, and 4-o’clock directions immediately after the surgical intervention ( P < .01) in both the autograft and the allograft groups. Although the SR and distance to dislocation decreased subsequently, autografts showed long-term effects on SR and dislocation distance in the 3-o’clock direction ( P < .01) and on SR in the 4-o’clock direction ( P < .01). Allografts showed no significant effect on SR and dislocation distance in long-term follow-up ( P > .05). Overall, glenoid retroversion as well as cavity depth predicted stability in all 4 dislocation directions, with glenoid cavity depth showing the highest correlation coefficients ( R = 0.71, 0.8, 0.73, and 0.7 for 2-, 3-, 4-, and 5-o’clock, respectively). Conclusion: The autologous ICBGT procedure biomechanically improved anterior shoulder stability in long-term follow-up, whereas the use of allografts did not show any bone-mediated biomechanical effect at follow-up due to resorption. Furthermore, in addition to measurements of defect extent, the glenoid depth and version seem to be useful parameters to determine the biomechanical effect and need for glenoid bone grafting in patients with shoulder instability. Clinical Relevance: This study proposes the use of autologous bone grafts for a successful long-term stabilization effect. Additionally, this study proposes additional glenoid morphological measures to predict shoulder stability.

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Combined fractures of the humeral head and the glenoid

Cited by 6 publications

References 52 publications

A Unique Presentation of the Glenoid, Coracoid, and Proximal Humerus Fractures

A Unique Presentation of the Glenoid, Coracoid, and Proximal Humerus Fractures

The ‘Floating Humeral Head’, A Case Series of Combined Proximal Humeral and Glenoid Fracture Dislocations

The Biomechanical Effect of Bone Grafting and Bone Graft Remodeling in Patients With Anterior Shoulder Instability

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