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Konservative Therapie anteroinferiorer Glenoidfrakturen

Conservative therapy of antero-inferior glenoid fractures

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Zusammenfassung

Die Therapie anteroinferiorer Glenoidfrakturen wird kontrovers diskutiert. Besonders über die Resultate nach konservativer Therapie ist wenig bekannt. Ziel der vorliegenden Studie ist es daher, die klinischen und radiologischen Ergebnisse konservativ behandelter Patienten mit akuten Glenoidranddefekten vom Fragmenttyp (Typ Ib) und zentriertem Glenohumeralgelenk zu evaluieren.

Zehn Patienten (5 weiblich/5 männlich, durchschnittliches Alter 56,5 Jahre) wurden retrospektiv unter Erhebung des Rowe Score (RS), des Constant Score (CS), des Western Ontario Shoulder Instability Index (WOSI) und des Subjective Shoulder Value (SSV) sowie einer radiologischen Diagnostik mit True-a.p.- und axialen Röntgenaufnahmen nachuntersucht.

Nach einem mittleren Nachuntersuchungszeitraum von 26,4 Monaten berichtete kein Patient über eine Reluxation, Resubluxation oder ein persistierendes Instabilitätsgefühl. Im Bewegungsumfang konnte kein signifikanter Unterschied im Vergleich zur gesunden Gegenseite ermittelt werden (p >0,05). Es ergab sich im RS ein Median von 95 (Range 70–100 Punkten), im CS von 80,5 (Gegenseite 84 Punkte, p >0,05), im WOSI von 86,7 (Range 51–99,6%) und ein SSV von 85 (Range 50–100%). Alle Fragmente waren mit einer mittleren Gelenkstufe von 2 (0–6 mm) konsolidiert. Die anteriore subchondrale Sklerosezone war in 7 Fällen komplett reformiert. In 2 Fällen konnte eine symptomlose Instabilitätsarthrose Grad I bzw. II nach Samilson u. Prieto beobachtet werden. Letztere war zum Zeitpunkt des Traumas bereits vorhanden.

Die konservative Therapie akuter solitärer Glenoidranddefekte vom Fragmenttyp Typ Ib kann sehr gute bis zufrieden stellende klinische Ergebnisse liefern und stellt insbesondere bei Patienten im mittleren Lebensalter eine geeignete Alternative zur operativen Versorgung dar. Die genauen Indikationen für ein konservatives vs. operatives Vorgehen gilt es in weiterführenden Studien zu klären.

Abstract

The adequate treatment of antero-inferior glenoid rim fractures is a controversial issue. Marginal knowledge exists about the results of non-operative treatment. Therefore, the aim of this study was to evaluate the results of conservative treatment of acute fragment type lesions (type Ib) of the antero-inferior glenoid.

A total of 10 patients (5 female and 5 male, mean age 56.5 years) were included in this retrospective study. A complete clinical examination of the shoulders and four functional scores, the Constant Score (CS), Rowe Score (RS), Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) as well as a radiologic evaluation using true a/p and axillary radiographs were performed.

After a mean follow-up of 26.4 months no clinical signs of subjective instability or redislocation were found. The median CS reached 80.5 points (range 52–88) versus 84 points (range 73–90) on the healthy contralateral side (p >0.05). The RS, WOSI and SSV achieved 95 points (range 70–100), 86.7% (range 51–99.6%) and 85 % (range 50–100%), respectively. The radiologic evaluation showed a consolidated fragment in all patients. The anterior subchondral sclerosis zone was reformed completely in seven patients. The mean intra-articular step-off was 2 mm (range 0–6 mm). Osteoarthritis was seen in two cases (one grade I and one grade II according to Samilson and Prieto) none of which was symptomatic and the one grade II was present at the time of trauma.

The conservative treatment of acute fragment type lesions (type Ib) of the antero-inferior glenoid can lead to excellent and satisfactory clinical results and therefore represents a suitable treatment alternative in the middle aged patient population. Nevertheless, future studies have to explicitly define the exact indications for a conservative versus surgical treatment approach.

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie (CMSC), Charité-Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Deutschland

    N. Kraus, C. Gerhardt, N. Haas &  M. Scheibel

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  1. N. Kraus
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  2. C. Gerhardt
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  3. N. Haas
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  4. M. Scheibel
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Correspondence to M. Scheibel.

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Kraus, N., Gerhardt, C., Haas, N. et al. Konservative Therapie anteroinferiorer Glenoidfrakturen. Unfallchirurg 113, 469–475 (2010). https://doi.org/10.1007/s00113-010-1754-3

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