Arthroscopic reduction and fixation of large solitary and multifragmented anterior glenoid rim fractures

Abstract

Background: The optimal treatment of large anterior glenoid rim fractures is still a matter of debate. The purpose of this study was to evaluate the clinical and radiologic results of an arthroscopic reduction and fixation of acute displaced large solitary or multifragmented anterior glenoid rim fractures using anchors or bioabsorbable compression screws.

Methods: Twenty-three consecutive patients (7 women, 16 men; mean age, 47.9 [15-74] years) were treated. The patients were followed up clinically (range of motion, instability testing, and shoulder outcome scores) and with conventional radiographs (true anterior-posterior, axillary, and Bernageau views).

Results: With a minimum follow-up of 24 months, 21 patients could be evaluated. The average Constant score was 84.5 points, the Rowe score was 90.8 points, the Melbourne Instability Shoulder Score was 96.2 points, the Western Ontario Shoulder Instability Index was 89.2%, and the subjective shoulder value averaged 92.1%. No patient had suffered recurrent instability. The radiologic evaluation revealed signs of osteoarthritis in 7 cases, which was pre-existing in 1 patient. Patients with osteoarthritis were on average 10 years older at the time of surgery compared with patients without osteoarthritis. A postoperative step-off of the glenoid was detected in 7 cases and averaged 2 (1-3) mm. We could not find a correlation between the step-off and the presence of osteoarthritis.

Conclusion: Arthroscopic reconstruction of acute large solitary and multifragmented fractures of the glenoid rim shows good and excellent clinical results. In the majority of cases, an anatomic reduction and healing of the glenoid fracture can be achieved. The rate of osteoarthritis needs further investigation.

Keywords: Anterior glenoid rim fracture; arthroscopic reconstruction; screw fixation.