Blog Elements - Acta of Shoulder and Elbow Surgery

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Arthroscopic treatment of Glenoid Fractures

January 10, 2017/0 Comments/in Vol 2| Issue 1| Jan-June 2017 /by ASESADMIN2016

Acta of Shoulder and Elbow Surgery | Volume 2| Issue 1 | Jan-Jun 2017 | Page 15-21| Américo Zoppi Filho, Américo Zoppi Netto Authors: Américo Zoppi Filho [1], Américo Zoppi Netto [1] [1] Unicamp and University of Sao Paulo [2] Consultant Shoulder Surgeons, Sao Paulo – Brazil Address of Correspondence Dr. Américo Zoppi Filho Consultant […]

Management of Glenoid Bone Loss in Reverse Shoulder Arthroplasty

January 10, 2017/0 Comments/in Vol 2| Issue 1| Jan-June 2017 /by ASESADMIN2016

Acta of Shoulder and Elbow Surgery | Volume 2| Issue 1 | Jan-Jun 2017 | Page 28-31| Eric Wagner, John W Sperling Authors: Eric Wagner [1], John W Sperling [1] [1] Mayo Clinic Rochester-MN-USA Address of Correspondence Dr. Eric Wagner Mayo Clinic Rochester-MN-USA Emial: wagner.eric@mayo.edu Abstract Reverse shoulder arthroplasty has greatly improved the outcome of patients […]

Arthroscopic treatment of Glenoid Fractures

January 10, 2017/0 Comments/in Vol 2| Issue 1| Jan-June 2017 /by ASESADMIN2016

Management of Glenoid Bone Loss in Reverse Shoulder Arthroplasty

January 10, 2017/0 Comments/in Vol 2| Issue 1| Jan-June 2017 /by ASESADMIN2016

Full Sized Blog Element (Big Preview Pic)

Arthroscopic treatment of Glenoid Fractures

January 10, 2017/0 Comments/in Vol 2| Issue 1| Jan-June 2017 /by ASESADMIN2016

Authors: Américo Zoppi Filho [1], Américo Zoppi Netto [1]

[1] Unicamp and University of Sao Paulo
[2] Consultant Shoulder Surgeons, Sao Paulo – Brazil

Address of Correspondence
Dr. Américo Zoppi Filho
Consultant Shoulder Surgeons, Unicamp and University of Sao Paulo
Email: zoppi@uol.com.br

Abstract

Arthroscopic joint surgery has recently undergone an exponential evolution, expanding its applications in traumatology allowing that ORIF techniques could be performed by using minimally invasive methods within the intraarticular space. However arthroscopic glenoid fixation for acute fractures have not been usually reported in the literature. This study presents a case series of arthroscopic fixation of the anterior glenoid. The six-month assessments using the UCLA Score, showed Good/Excellent results in 11/12 patients.
None of the patients presented recurrences of the dislocation and range of motion loses were minimal.
Keywords: Glenoid Fractures, Arthroscopic treatment, functional outcome.

Introduction

Arthroscopic joint surgery has recently undergone an exponential evolution, expanding its applications in traumatology allowing that ORIF techniques could be performed by using minimally invasive methods within the intraarticular space [1].
The isolated fractures of the glenoid rim are many times associated with shoulder dislocation [2], and according to the abduction and rotation of the arm, can compromise small or larger parts of the bone [3] (small undisplaced fractures; larger and displaced fractures; cominutive fractures). Most of the time are single fracture or small cominuation; such characteristics allow a firm fixation using screws [4] and/or suture anchors [5] by using arthroscopic techniques.
Glenoid fractures associated with others parts of the bone, are treated different requiring an open reduction and internal fixation [6].
Most of the glenoid fractures reported thus have been associated with shoulder dislocation, and are results of high energy trauma [2].
The surgical procedures are indicated if the shoulder is unstable after reduction [3].
Small fragments (< 5mm) and patients 50 years of age and older, are best treated non-surgically, showing good results as pain and joint mobility are evaluated. Larger and displaced fragments, involving more than 20% of the articular surface, can curse with a unstable shoulder, requiring surgery [7].

Methods

From 2004 to 2015, we treated 12 patients (12 shoulders) with a displaced glenoid fracture, following a shoulder dislocation; 10 were men, and 2 women. Ages ranging from 20-61 years old, with a mean age of 33.2; 6 patients dislocated their shoulders in a motorcycle accident; 1 in a bike accident; 1 skiing and 4 falling from standing height.
The time between the trauma and the surgery was 3-14 days (mean 4.8 days). They all had articular instability, and a “loosen shoulder felling” during the ROM, at any degree.
In 9 cases, only 1 cannulated screw was necessary; 3 cases required 2 screws (Fig 2-A and Fig 2-B). In 2 patients, a labral repair was necessary to be added, using 1 suture anchor; 1 patient had a cominutive fracture, requiring the use of the 2 sutures anchors.

Treatment

The arthroscopic treatment of glenoid fractures can be performed using the same technique and materials of labrum repair or cannulated screws.
We prefer the beach chair position; the optical goes on the posterior portal and instrumentation in the antero superior and antero inferior portal
The first step, and extremely important one, is to irrigate overly the shoulder cavity, to wash away the hematoma and any debris.
Usually, the bony fragment is displaced in an inferior and medial position in relation to the articular surface.
After identification, the fragment is cleared of any debris, allowing it’s free mobility, and a K wire is used as a joystick (Fig 1-A), aiding the reduction.
Preferably, the procedure should take place within few days of the trauma; any delay of that time can make the reduction harder, due to fibrous tissue.
Once the reduction has been achieved, the fragment is than fixed with a K wire (Fig 1-B); special attention should be taken not to fix the fragment in a too inferior position, risking any damage to the axilar nerve.

After the reduction and fixation of the fragment has been completed, we use K wire as a guide to place a cannulated screw of a smaller diameter as a final hardware fixation device. This is a particular difficult step; the apparatus to insert the screw is usually short, making the use of cannulas nearly impossible, especially in patients with a developed muscles in the shoulder area. Quite often the cannulas are removed, and a mini open access is used.
Other important detail is the location of the screw; the suture anchors or screws can be placed closer to the articular surface (near the border, in a extra articular position), avoiding any interference with the articular cartilage or mobility of the shoulder (Fig 2 A,B).
The post op care and rehab protocols were similar to glenohumeral instability.

Results

The six-month assessments using the UCLA SCORE, showed Good/Excellent results in 11 patients. The oldest patient (61 years old) had post traumatic arthrosis (seen on imaging studies), with mild pain, mild instability, and small deficit ROM.
None of the patients presented recurrences of the dislocation. Loss of range of motion was minimal. A minimal discomfort was present in 11/12 patients mainly in the extremes of the movement.
Discussion
Glenoid fractures are cause of recurrent anterior shoulder instability [8] thus the fracture fixation can be one of the best options for treating this traumatic condition.
There are just few papers related to this technique and this study’s data reproduces the current literature’s success [9].
The arthroscopic method for handle bony surgeries present advantage of the minimally invasive procedures [10] but will also need more training and arthroscopic skills [11].
This is one of the largest series in literature and presents promising results for treating acute fractures of the anterior glenoid rim by using a minimally invasive procedure.
To this moment the author has just assessed six-months post-surgery, however longer follow up is required in order to assess long term advantages and complications related to this procedure.

References

1 Giudici LD, Faini A, Tucciarone A and Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFFORT Open Rev. 2016; 1(9): 325-331.
2 Ideberg R, Grevsten S & Larsson S. Epidemiology of scapular fractures: Incidenceand classification of 338 fractures. Acta Orthop Scand. 1995 Oct;66(5):395-7.
3 Bigliani LU, Newton PM, Steinmann SP, Connor PM, McLlveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med. 1998;26:41–45.
4 Cameron SE. Arthroscopic reduction and internal fixation of anterior glenoid fracture. Arthroscopy. 1998;14(7):743-746.
5 Sugaya H, Kon Y and Tsuchiya A. Arthroscopy: Arthroscopic Repair of Glenoid Fractures Using Suture Anchors, Arthroscopy. 2005; 21(5), May, 2005: pp 635.e1-635.e5
6 Ada JR and Miller ME. Scapular Fractures: Analysis of 113 cases. Clin. Orth. Rel. Res. 1991; 269:174-180.
7 Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E et al. The stabilizing mechanism of the Latarjet procedure: A Cadaveric Study. J Bone Joint Surg Am. 2013; 95:1390-1397
8 Dana PP, Verma NN, Romeo AA, Levine WN, Bach BRJr and Provencher MT. Glenoid Bone Deficiency in Recurrent Anterior Shoulder Instability: Diagnosis and Management. JAAOS. 2009; 17(8):482-493.
9 Tauber, M., Moursy, M., Eppel, M. et al. Knee Surg Sports Traumatol Arthr. 2008; 16: 326-332.
10 Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R & Kochhar T. The arthroscopic Latarjet procedure for treatment of anterior shoulder instability. Arthroscopy. 2007; 23:1242e1–1242e5
11 JC Garcia Jr. Arthroscopic Bristow – Latarjet Procedure: Results and Technique after nine-year experience. Acta of Shoulder and Elbow Surgery Oct – Dec 2016;1(1):27-34.

How to Cite this article: Filho A Z, Netto A Z. Arthroscopic treatment of Glenoid Fractures. Acta of Shoulder and Elbow Surgery Jan – June 2017;2(1):33-36.

(Abstract Full Text HTML) (Download PDF)

Dr. Américo Zoppi Filho

Management of Glenoid Bone Loss in Reverse Shoulder Arthroplasty

January 10, 2017/0 Comments/in Vol 2| Issue 1| Jan-June 2017 /by ASESADMIN2016