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.
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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration (version of 64th WMA General Assembly, Fortaleza, Brazil, October 2013). Agree of Ethic Committee Prat. 68/17 Prot. numb 2835/C.E. 25/07/2017.
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Corradini, A., Campochiaro, G., Gialdini, M. et al. Arthroscopic repair of glenoid rim fractures: a ligamentotaxis surgical technique. Musculoskelet Surg 102 (Suppl 1), 41–48 (2018). https://doi.org/10.1007/s12306-018-0558-4
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DOI: https://doi.org/10.1007/s12306-018-0558-4