Research progress in the diagnosis and treatment of the glenoid fractures / 中华创伤骨科杂志

The anatomy of the shoulder joint is complex. Glenoid fractures, intra-articular fractures of the shoulder, are relatively rare and often accompanied by serious injury. At present, there has been no consensus on the optimal strategies for their treatment. Insufficient knowledge and improper treatment of the surgeons may seriously affect the shoulder function of the patients to harm their quality of life. Therefore, proper handling of such fractures is a major challenge in clinic. In recent years when high-energy injuries are increasing and functional recovery after shoulder fracture is emphasized by more and more patients, great efforts have been put into the research into such fractures by orthopedic surgeons. This reviews expounds on the anatomy, diagnosis, classification and treatment of glenoid fractures, aiming to provide useful reference for the orthopaedic surgeons who deal with glenoid fractures.

Clinical analysis of posterior axillary approach internal fixation for IdebergⅠa andⅡglenoid fractures / 中国骨伤

OBJECTIVE@#To investigate the efficacy of posterior axillary approach internal fixation for Ideberg Ⅰa andⅡ glenoid fractures.@*METHODS@#From December 2018 to September 2021, 9 patients with lower part of glenoid fractures were treated by posterior axillary approach, including 3 males and 6 females, aged from 50 to 78 years old. All the fractures were closed fractures. According to Ideberg type of scapular glenoid fracture was type Ⅰa in 6 cases and type Ⅱ in 3 cases. AP and lateral X-ray films of scapula were taken at 6, 12 weeks and 6 and 12 months postoperatively. Constant-Murley and disabilities of the arm shoulder and hand (DASH), and other complications were recorded at the latest follow-up.@*RESULTS@#Nine patients were followed up, ranged from 6 to 15 months. And bone healing was achieved in all 9 patients at the final follow-up, the healing time 3 to 6 months, Constant-Murley score at the final follow-up ranged from 55 to 96, and DASH score ranged from 3.33 to 33.33. Both of them were better than preoperative.@*CONCLUSION@#The posterior axillary approach internal fixation for Ideberg Ⅰa and Ideberg Ⅱ Glenoid fractures scapular fracture is satisfactory and worthy of clinical application.

Treatment of proximal humeral fracture combined with lower glenoid fracture by internal fixation via the posterior axillary approach and the deltoid pectoralis major approach / 中华创伤骨科杂志

Objective:To investigate the efficacy of the posterior axillary approach combined with the deltoid pectoralis major approach in the treatment of proximal humeral fracture combined with lower glenoid fracture.Methods:From July 2019 to September 2021, 7 patients were treated at Department of Traumatic Othopeadics, The Sixth Hospital of Ningbo for proximal humeral fracture combined with lower glenoid fracture by internal fixation via the posterior axillary approach combined with the deltoid pectoralis major approach. They were 2 males and 5 females, aged from 51 to 78 years (average, 62.9 years). All fractures were closed ones. According to the Neer classification for the proximal humeral fractures, there were one case of type Ⅱ, one case of type Ⅲ, 3 cases of type Ⅳ and 2 cases of type Ⅵ. According to the Ideberg classification for the glenoid fractures, 5 cases were type Ⅰ and 2 cases type Ⅱ. The anteroposterior, lateral and axillary X-ray films of the affected shoulder were taken at 6 and 12 weeks, and 6 and 12 months after operation to follow up fracture healing and occurrence of complications. The Constant-Murley shoulder joint scores and the Disability of Arm Shoulder and Hand (DASH) scores for the upper limb dysfunction were recorded at the last follow-up for all patients.Results:All the 7 patients were followed up for 8 to 15 months (mean, 11.9 months). Bone union was achieved after an average of 4.3 months (from 3 to 6 months) in all patients. None of the functional activities was affected in all by postoperative shoulder joint instability, incision infection or axillary scar hyperplasia. At the last follow-up, their Constant-Murley scores averaged 83.4 points (from 55 to 92 points), and their DASH scores 13.5 points (from 4.2 to 33.3 points).Conclusion:In the treatment of proximal humeral fracture combined with lower glenoid fracture, the posterior axillary approach combined with the deltoid pectoralis major approach can lead to fine early curative efficacy due to their advantageous possibilities to allow for easy fracture reduction, reliable fixation and early rehabilitation.

Clinical features and treatment of anterior shoulder dislocation complicated with fractures of glenoid and greater tuberosity / 中华创伤骨科杂志

Objective:To explore the clinical features and treatment of anterior shoulder dislocation complicated with fractures of glenoid and greater tuberosity (GT).Methods:From December 2013 to October 2019, 26 patients (27 shoulders) were treated at Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital by arthroscopy or open reduction and internal fixation (ORIF). They were 13 males and 13 females with a mean age of 49.1 years (range, from 22 to 71 years). By the Goss-Ideberg classification for glenoid fractures, there were 21 cases of type Ⅰa and 6 cases of type Ⅱ; by the Mutch classification for GT fractures, there were 3 cases of depression type, 6 cases of avulsion type and 18 cases of split type. At the last follow-up, visual analogue scale (VAS), Constant-Murley and American Shoulder & Elbow Surgeons (ASES) scores were used to evaluate the pain and function of the shoulder and the Rowe scores to assess shoulder stability.Results:In this cohort, the avulsion type accounted for 66.7% (18/27) of the GT fractures and the type of anterior glenoid rim for 77.8% (21/27) of the glenoid fractures. All the 26 patients (27 shoulders) were followed up for a mean period of 18.3 months (range, from 12 to 47 months). All fractures united after 6 to 17 weeks (mean, 11.6 weeks). At the last follow-up, anterior flexion and lifting averaged 155.6°, lateral external rotation 43.6°, and the internal rotation thumb touching the spinous process levels from L4 to T8. At the last follow-up, the Constant-Murley scores averaged 89.2, the ASES scores 88.9, the Rowe scores 94.5, and the VAS scores 0.3.Conclusions:In anterior shoulder dislocation complicated with fractures of glenoid and GT, the GT fractures are mainly the split type and the glenoid fractures mainly the type of anterior glenoid rim. Arthroscopy or ORIF can be used to repair rotator cuff tears and restore shoulder stability, leading to significantly improved shoulder function and satisfactory therapeutic outcomes.