Results and Functional Outcome of Arthroscopically-assisted Fixation of Glenoid Fractures: Three Cases

Abstract

Severely displaced glenoid fractures require open reduction and internal fixation to avoid chronic instability or degenerative changes. Arthroscopic techniques potentially facilitate accurate fracture reduction and fixation without the need for extensive surgical dissection. We report three male patients (mean age 26 years; range 17 years to 40 years) who underwent arthroscopically‐assisted reduction and internal fixation for a displaced Ideberg type III (two cases) or IV glenoid (one case) fracture. Cannulated, partially‐threaded screws were inserted percutaneously via a superior approach just anterior to the clavicle in all cases. Patients were assessed postoperatively with serial radiographs and clinically using the Constant–Murley shoulder score (0 points to 100 points) at 1 year. There were no recorded complications of surgery, and all fractures united within 3 months. At 6 months, all patients returned to their previous levels of activity and regained an excellent range of motion. The mean Constant–Murley shoulder score at 1 year was 95 points (range 94 to 96), and there was no radiological evidence of arthrosis. Arthroscopic fixation of transverse‐orientated glenoid fractures can have excellent functional results, and percutaneous screw insertion via a superior approach appears to be a safe and reproducible technique.

The Role of Arthroscopy in Contemporary Glenoid Fossa Fracture Fixation

“…The final fixation is typically achieved with percutaneously placed or cannulated screws [28,101]. Postoperative CT scans can be performed to evaluate the quality of fracture reduction and check the screw position and length [102] (Figure 4). Percutaneous application of elevators or Kirschner wires can be used to disengage mobilize, and reduce the bone fragments in order to restore the articular congruity [97,98] Afterward, the fractures are provisionally stabilized with the use of a reduction clamp o with the advancement of Kirschner wires and guide pins of cannulated screws unde fluoroscopy [28,99,100].…”

“…The final fixation is typically achieved with percutaneously placed or cannulated screws [28,101]. Postoperative CT scans can be performed to evalu ate the quality of fracture reduction and check the screw position and length [102] (Figur 4). A review of the literature on studies about the arthroscopy-assisted fixation of gle noid fossa fractures was conducted, and the results are summarized in Tables 2-4.…”

“…Arthroscopic reduction and percutaneous fixation have also been successfully performed in Ideberg type III glenoid fractures [28,88,98,[102][103][104][105]. In most cases, the beachchair position is selected, and the C-arm fluoroscope is placed in ipsilateral or contralateral side of the affected limb [88,102]. However, some surgeons prefer the lateral decubitus position [98].…”

“…However, some surgeons prefer the lateral decubitus position [98]. After arthroscopic debridement, the superior fragment is usually manipulated and reduced using Kirschner wires [102]. As the coracoid process is in continuity with the displaced superior part of the articular surface, a serrated reduction clamp, or "lobster jaw", can be used to grasp the process and obtain satisfactory fracture reduction [28,88,105].…”

“…When adequate reduction of the Ideberg type III fractures is confirmed, the wires used for manipulation of the superior glenoid fossa are advanced to the inferior part. Cannulated screws are subsequently introduced to stabilize and compress the fracture site [102]. Supplementary materials could also be used during arthroscopy to achieve the optimal position of the guide wire.…”