Glenoid Fractures

Abstract

Glenoid fractures are uncommon injuries frequently associated with shoulder dislocation and high-energy trauma. Due to limited published scientific data, little is known about the optimal treatment strategies. In order to properly assess and manage these fractures, distinction in patomechanics and fracture type is necessary. We should distinguish between glenoid avulsions, glenoid rim fractures, and the fractures of the glenoid fossa. In significantly displaced fractures, surgical treatment is recommended to avoid chronic shoulder instability or degenerative changes of the joint. When the glenohumeral joint lays centered on the glenoid cavity, outcome is generally good in non-operative treatment. The main parameters defining indications for operative treatment are instability, the articular surface fragment size, and to lesser extent the degree of displacement. Operative treatment is therefore indicated if the humeral head is not centered on the glenoid, if the size of the fragment exceeds 20–25% of the glenoid surface in anterior and 33% in posterior glenoid fractures, and if there is more than 5 mm displacement of the fracture fragment. In the last two decades, there is marked evolution in arthroscopically assisted and all arthroscopic surgical technique for glenoid fractures. Fracture fixation with suture anchors or screws is effective. Arthroscopic treatment of these injuries is safe and reliable with some important benefits recognized. Minimally invasive techniques allow preservation of blood supply and can reduce the risk of restricted motion, which can be seen after open procedures. Advantage of direct visualization and soft tissue preservation in the same time may lead to improved clinical outcome. In the future, more comparative studies may give us scientific evidence on the ideal indication for operative treatment and evidence on different treatment methods and their outcome.