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Ossification of the glenoid is a predictable developmental process in adolescents. However, a lack of knowledge of the variability of this process provides a challenge in discerning between normal adolescent development and shoulder pathology. We presented a case of a 15-year-old male with chronic intermittent right shoulder pain who was diagnosed with a labral tear based on presentation, physical exam, and magnetic resonance arthrogram. He subsequently underwent a diagnostic arthroscopy which revealed no evidence of labral or bony pathology and was instead concluded to have an incomplete ossification of the glenoid. His symptoms were assessed to be related to rotator cuff tendinitis, for which he underwent focused physical therapy which resulted in complete resolution of symptoms at his 1-month postoperative follow-up. Understanding the normal ossification process of the glenoid clinically and through imaging can help physicians recognize normal shoulder development and avoid misinterpretation of findings as pathology in adolescent patients.

Introduction: The combination of anterior large glenoid rim fractures (GRF) and proximal humerus fractures (PHF) is rare, with limited data available on specific treatments for these glenohumeral combination fractures (GCF). This study aimed to evaluate the treatment approaches for GCF, analyze patient outcomes, and outline surgical management strategies for different fracture types. Materials and methods: This retrospective study included patients with GCF, excluding those with fossa glenoidalis fractures, isolated greater tuberosity fractures, or small glenoid rim fractures (< 5 mm). Preoperative radiographs, CT scans, and follow-up radiographs were reviewed. Clinical outcomes were assessed using the Constant-Murley Score (CMS), Western Ontario Shoulder Instability Index (WOSI), Rowe Score (RS), and Oxford Shoulder Score (OSS). Results: Sixteen patients with 17 GCFs (mean age 62 years) were followed for an average of 39 months. PHFs were categorized into three-part (76%), four-part (12%), and two-part fractures (12%). The average medial displacement of GRF was 5 mm, with an average dehiscence of 4 mm in the sagittal plane. Fourteen patients (88%) underwent surgical treatment; 35% had only the PHF surgically addressed, while 53% had both lesions surgically treated. Two patients (12%) received non-operative treatment. Complications were observed in 29% of cases, primarily involving the humeral side. The average CMS was 68 points, WOSI was 75%, RS was 77 points, and OSS was 41 points. Conclusion: Treating GCF is complex and routinely necessitates surgical intervention, with or without GRF refixation. CT imaging is crucial for precise assessment of fracture morphology. The involvement of the minor tuberosity is critical in selecting the optimal surgical approach and managing the subscapularis muscle. [ABSTRACT FROM AUTHOR]

Glenoid fossa fractures are rare injuries accounting for 10 to 29% of all intra-articular scapula fractures. They are usually the result of high-energy trauma, and concomitant injuries are not uncommon. Patients with glenoid fractures are admitted with shoulder pain and restricted range of motion. Although shoulder plain radiographs could establish the diagnosis, a computed tomography scan is necessary to adequately define the fracture pattern and characteristics. The most commonly used classification system is that of Ideberg (modified by Goss), which includes five glenoid fossa fracture types according to the location, extension, and complexity of the lesion. Articular surface displacement and step-off are the most important factors that should be taken under consideration when deciding for conservative or surgical management. Operative treatment includes open reduction and internal fixation through a posterior or anterior approach depending on fracture morphology and displacement. However, open surgical techniques are related to extensive soft-tissue disruption, risk of neurovascular injury, and inadequate exposure of the entire glenoid cavity. Introduction of arthroscopy could facilitate better visualization of the glenoid articular surface and improved fracture reduction. However, it is a technically demanding procedure with many challenges and pitfalls. The aim of this review is to summarize the current evidence regarding the treatment of glenoid fossa fractures and present the beneficial effect of arthroscopy in improving the quality of fracture fixation and overall functional outcomes. [ABSTRACT FROM AUTHOR]

Case Presentation: A 64-year-old man presented to the emergency department with a chief complaint of left shoulder pain after a mechanical fall from standing. Plain radiography revealed a displaced fracture of the inferior glenoid rim. A computed tomography further characterized the fracture and the patient was taken emergently by an orthopedic surgeon for open reduction and internal fixation.Discussion: Scapula fractures, especially isolated glenoid rim fractures, are rare and most typical of high-energy mechanism traumas. A missed or delayed diagnosis can result in long-term suffering and disability. Awareness of radiographic as well as physical findings and the subsequent classification system described below can optimize outcomes for trauma patients with glenoid fractures.

Background: With recurrent anterior instability the bone fragment of a bony Bankart lesion is often small compared to the glenoid defect. The purpose of the present study was to clarify the changes to both the bone fragment and glenoid defect over time in a single subject. Methods: Participants were patients who underwent computed tomography (CT) at least twice after an instability event between 2004 and 2021 and had a fragment-type glenoid at first CT. The glenoid rim width (A), glenoid defect width (B), and bone fragment width (C) were measured in millimeters. If B or C increased by 1 mm or more from the first to final CT, the change was judged as “enlarged,” and if B or C decreased by 1 mm or more, it was judged as “reduced”; all other cases were judged as “similar.” Then, glenoid defect size and bone fragment size were calculated as B/A×100% and C/A×100%, respectively, and the changes from the first to final CT were compared. Results: From the first to final CT, the glenoid defect was enlarged in 30 shoulders, similar in 13 shoulders, and reduced in 4 shoulders, and the bone fragment was enlarged in 18 shoulders, similar in 24 shoulders, and reduced in 5 shoulders. The mean glenoid defect size significantly increased from 10.9% to 15.3% (P

Introduction: The purpose of this series is to report on the one-year clinical outcomes of instability related anterior glenoid fractures treated with open repair utilizing the subscapularis split technique. Methods: Patients with displaced anterior glenoid fractures who underwent open surgical treatment via deltopectoral incision and subscapularis split were identified from a single surgeons database. Fractures were repaired using screw fixation or with distal tibia osteochondral allograft reconstruction. Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test (UE), PROMIS Pain interference (PI), PROMIS pain intensity (Pi), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain, and Subjective Shoulder Value (SSV) scores were obtained at minimum one-year follow-up. Results: Twelve patients with a mean age of 54 (range 28–72) years were included in our study with a follow-up at an average of 16.6 (range 12–30) months. Ten patients underwent internal fixation and two patients underwent allograft reconstruction. Postoperative imaging (n = 10) at latest follow-up demonstrated healed fractures without any hardware complication. Mean postoperative range of motion included forward elevation of 147 ± 44.0° and external rotation of 44 ± 17°. Postoperative PROMs were obtained from nine patients with a mean PROMIS UE, PI, and Pi score of 49.4 ± 4.1, 39.9 ± 3.8 and 35.6 ± 4.3, respectively. The respective mean ASES, VAS, and SSV scores were 91.8 ± 7.2, 1.2 ± 1.0, and 91.0 ± 8.0. Conclusion: Open surgical repair of anterior glenoid fractures utilizing subscapularis split results in good functional outcomes and low complications including risk of recurrent instability. Level of Evidence: III case series. [ABSTRACT FROM AUTHOR]

Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Shoulder dislocations may lead to anterior glenoid rim fractures. An all-arthroscopic double-row repair, referred to as bony Bankart bridge (BBB), has been proposed with superior biomechanical properties when compared to single-row repair techniques. The aim of the present study was to evaluate the minimum 10-year clinical and functional outcomes following BBB., Methods: All consecutive patients that underwent arthroscopic BBB for the treatment of shoulder instability with an associated bony Bankart lesion by a single surgeon between December 2007 and February 2013 were eligible for inclusion. Preoperatively and minimum 10 years postoperatively, patient-reported outcome measures (American Shoulder and Elbow Surgeons [ASES] Score, short version of the Disabilities of the Arm, Shoulder and Hand questionnaire [QuickDASH], Single Assessment Numeric Evaluation [SANE], 12-Item Short-Form Health Survey Physical Component Summary [PCS-12]), satisfaction with the postoperative result [1-10 scale with "10" indicating maximum satisfaction], and Visual Analog Scale [VAS] for pain), return to sport rates, as well as instability recurrence and revision surgery rates were evaluated., Results: Eleven patients (100% male) with a mean age at the time of surgery of 48.0 (interquartile range, 31.0-62.0) years were evaluated 14.0 (11.0-14.0) years postoperatively. At long-term follow-up, significant improvements in shoulder function (ASES Score: 74.9 [30.8-90.8] vs. 100 [98.3-100], P < .001; QuickDASH: 13.6 [10.0-63.6] vs. 0.0 [0.0-6.8], P = .002; SANE: 50.0 [19.0-90.0] vs. 96.0 [89.0-99.0], P = .002) and physical health (PCS-12: 44.1 [35.1-55.7] vs. 57.3 [56.5-58.5], P < .001) were observed. Median satisfaction with the postoperative outcome was high (10 [5.0-10]). Pain levels were low (VAS for pain: 0 [0-0]). Ten patients reported their postoperative sporting activity level with the majority patients reporting sporting activity levels equal to or above (70.0%) their pre-injury level. One patient (9.1%) reported a shoulder re-dislocation during follow-up. No patients underwent further surgery for instability or post-traumatic osteoarthritis (PTOA)., Conclusion: The arthroscopic BBB for patients with bony Bankart lesions is associated with excellent shoulder function, low pain levels and high return to sport rates at long-term follow-up. One patient suffered a shoulder re-dislocation, but did not require revision surgery. No patients underwent further surgery for PTOA during follow-up., (Copyright © 2025. Published by Elsevier Inc.)

Mandibular fractures are frequently diagnosed in trauma centres. Tympanic plate and mandibular fossa fractures can be associated with those fractures and can pass unnoticed if a careful evaluation and adequate imaging exam are not performed. This descriptive study was made to evaluate the incidence of condylar fractures associated with mandibular fossa and/or tympanic plate fractures in a large trauma hospital. Twenty-nine patients were diagnosed with such fractures between July/2019 and July/2020. A total of 81.5% of the patients were diagnosed with condylar fracture associated with tympanic plate fracture, 11.1% with a condylar fracture with mandibular fossa fracture, and 7.4% with condylar fracture associated with both tympanic plate and mandibular fossa fracture. Otorrhagia, trismus, malocclusion, and mouth opening deviation were the most observed clinical signs. Treatments performed were speech therapy, open reduction, and closed reduction. A total of 7.4% of the patients evolved with complications after the treatment. This study suggests that fractures of the tympanic plate and mandibular fossa may go unnoticed if an adequate imaging exam is not performed and rated by the surgeon. The early and corrected treatment prevents future sequelae, and a long-term follow up is essential. [ABSTRACT FROM AUTHOR]

Introduction: There is little data available on non-operative treatment of anterior glenoid rim fractures (GRF). Nothing is known about fracture size and displacement in comparison to clinical outcomes and instability in a mainly middle-aged patient population. The aim of this study was to demonstrate the results of non-operative treatment in anterior glenoid rim fractures with the special focus on potential instability/recurrence. Methods: The inclusion criteria were non-operatively treated anterior GRF of at least ≥ 5 mm width using the age- and gender-matched Constant/Murley score (a.-/g.-CMS) and the Western Ontario Instability Index (WOSI). Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill–Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. and axial radiographs) was classified according to Samilson/Prieto. Proportion of fractured glenoid and medial displacement were correlated with the recurrence rate and the clinical scores. Results: N = 36 patients could be followed-up after a mean of 4.4 years [12–140 month, average age: 58 (± 13, 33–86) years]. The a.-/g.-CMS was 93 (± 11, 61–100) points, and the WOSI was 81% (± 22%, 35–100%) on average. The mean intraarticular displacement was 4 mm (± 3 mm; 0–14 mm). The 2D-circle-method showed a mean glenoid fracture involvement of 21% (± 11, 10–52%). Two cases of frozen shoulders and one case with biceps pathology were associated with the trauma. Within the followed-up patient group re-instability has occurred in n = 2 patients (6%) within the first two weeks after trauma. Osteoarthritis was found in n = 11 cases. There was no correlation between the scores and the fracture size/displacement [(a.-/g.-CMS vs. displacement: r = − 0.08; p = 0.6; vs. size: r = − 0.29; p = 0.2); (WOSI vs. displacement: r = − 0.14; p = 0.4; vs. size: r = − 0.37; p = 0.06)], but very large (≥ 21%) fractures with displacement ≥ 4 mm showed slightly worse results without significant difference (a.-/g.-CMS p = 0.2; WOSI p = 0.2). The apprehension test was negative in all patients at final follow-up. Conclusion: Non-operative treatment of anterior GRF was associated with overall good results within a mainly middle-aged larger patient group. Re-instability is rare and is not associated with fragment size but can occur in the first weeks after trauma. Size and dislocation of the fracture is not a criterion for the prognosis of potential instability. Level of evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods: Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results: The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions: Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.

This study describes three cases of patients who were victims of facial trauma and evolved with a condylar fracture associated with a fracture of the tympanic wall and/or glenoid fossa. In addition, a review of English-language literature involving condylar fracture associated with glenoid fossa and/or tympanic plate fractures from 1992 to 2019 was performed. In this article, we demonstrated that most patients received conservative treatment (40.6%) followed by the group that underwent surgical treatment (34.3%), but the treatment must be individualized for each case. Mandibular deviations, facial nerve paresis and ankylosis of the temporomandibular joint were observed. These fractures occur rarely but are often unnoticed in imaging studies. Patients with associated condylar fractures should be provided with a long-term follow-up due to the risk of late complications such as ankylosis, the most common. [ABSTRACT FROM AUTHOR]

Objective Based on the morphological characteristics of glenoid and greater tuberosity (GT) fractures and the relationship between them, we explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fractures. Methods From December 2013 to December 2019, we retrospectively reviewed the clinical data of patients who were diagnosed with acute anterior shoulder dislocation associated with glenoid and GT fractures in our hospital. According to the fracture site, a glenoid fracture group and a greater tuberosity fracture (GT) group were established, and the morphological characteristics of both glenoid and GT fractures were measured and statistically analyzed. Results A total of 41 patients (43 shoulders) met the inclusion criteria (39 unilateral shoulders and 2 bilateral shoulders). The mean age was 50.21 years (range, 22–71 years). A total of 27 shoulder injuries (62.8%) were split GT fractures and 33 shoulder injuries (76.7%) were combined with rotator cuff tears. The mean size of glenoid fragments was 30.16% and the mean displacement was 8.85 mm. The mean size of GT fragments was 28.43 mm. The mean superoinferior and anteroposterior displacements of the GT fragment were 6.77 mm and 4.96 mm, respectively. There was a negative correlation between the size of glenoid and GT fracture fragments (r = −0.64, P < 0.05). The glenoid fragments in the Ideberg type Ia glenoid fracture group were smaller than those in the Ideberg type II glenoid fracture group (28.41% and 40.95%, respectively), while the size of GT fragments in the type Ia group were larger than those in the type II group (29.77 mm and 20.21 mm, respectively) (P < 0.05). The GT fragments in the split GT fracture group were larger than those in the avulsion or depression GT fracture group (33.69 mm, 19.07 mm and 21.12 mm, respectively), while the size of glenoid fragments in the split GT fracture group were smaller than those in the avulsion or depression GT fracture group (23.57%, 41.37%, and 43.42%, respectively) (P

Objective To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation. Methods From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks，8 weeks，3 months，6 months，1 year after surgery) regularly for at least 1 year. At the follow‐up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed. Results Of the 15 patients, there are seven cases of men, eight cases of women; aged 22–66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%–47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow‐up was 38.2 months (range, 12–70 months), and one case was lost to follow‐up. With fractures healing well, almost all patients had a good joint function. At the final follow‐up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T11 level; the mean Constant–Murley score was 94.6 points (range, 70–100 points); the mean ASES score was 94.6 points (range, 79–100 points); and the mean VAS score was 0.4 points (range, 0–2 points). No recurrent instability or re‐dislocation occurred. No patient had revision surgery. Conclusion Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow‐up time of more than 3 years.

Background: Glenoid rim fractures are uncommon and generally associated with high complication rates. The most common treatment techniques include screw or anchor fixation. Here, we introduce a new fixation method to treat Ideberg type 1 A fractures. Methods: A retrospective analysis was performed on patients treated with open reduction and plate fixation for Ideberg type 1 A fractures. The active range of motion capacity of both shoulders was recorded postoperatively. Constant-Murley score and Oxford disability index scores were used as outcome tools. Results: Five patients (three men and two women) were evaluated; their mean age was 56 years (standard deviation (SD), 10 years). The mean follow-up period was 25 months (range, 6–69 months); all fractures healed radiologically during the follow-up period. The mean Constant-Murley score was 80.36 (SD 11.01); the mean Oxford disability index was 37 (SD 9). The subsequent flexion and external rotation of the injured shoulders were similar to those of the uninjured side (injured vs. uninjured side: flexion, 176 ± 5.4 vs. 178 ± 4.4; external rotation, 48 ± 10.9 vs. 60 ± 0). No patient showed signs of osteoarthritis, stiffness, instability, or chronic pain at the last follow-up. Discussion: Open reduction and internal fixation with a plate is suitable for Ideberg type 1A glenoid fractures. [ABSTRACT FROM AUTHOR]

Introduction: Combined proximal humerus fracture dislocation and glenoid fracture is a rare combination of injuries which presents technical operative challenges. There is little evidence to guide surgical management. Case Report: We report a case of a proximal humerus fracture with anterior dislocation and glenoid fracture treated in the same sitting with open reduction and internal fixation with angular stability locking plate and cannulated screw. The surgical technique involved standard deltopectoral approach with coracoid osteotomy. Conclusion: By addressing both fractures operatively at the same time, we reported a satisfactory clinical and functional outcome with bony union of the fracture sites without instability at end of 1 year. Coracoid osteotomy may open an alternative pathway to treat complex proximal humerus injuries with ipsilateral glenoid fracture. [ABSTRACT FROM AUTHOR]

Level IV; Case report [ABSTRACT FROM AUTHOR]

In this article we report a 74 year old patient with Ideberg-type III fracture who was treated with indirect reduction and fixation. The patient was a sportive biker who suffered from a high energy trauma (road accident). X-ray revealed a scapula fracture, and only after a CT-Scan we could confirm the fracture type (Ideberg-type III glenoid fracture). The patient was operated and re-evaluated at follow-up. During the surgery we prefered not to access intra-articular due to the low joint involvement. He was able to resume his daily activities at two months postoperatively. At three months ASES Score was 91.5; Constant Score was 71 (vs 96 of unaffected arm). The patient revealed to be satisfied with the treatment, moreover the clinical results are encouraging in view of further improvements in the following months. [ABSTRACT FROM AUTHOR]

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ideberg type III glenoid fractures are relatively rare, and the mechanisms of injury and treatment strategies remain controversial. We reviewed the fracture patterns and final radiological findings in four cases. All fractures were wider on the medial side than on the side of the articular surface. All patients had multiple ipsilateral rib fractures; three out of four patients had a concomitant acromion fracture. Therefore, the mechanism of injury for the fracture is assumed to be external force applied in the caudal direction to the medial side of the body of the scapula. The superior shoulder suspensory complex was disrupted in most cases. A good clinical outcome was obtained in two patients with percutaneous screw fixation for the glenoid fracture and rigid plate fixation for the acromion fracture and in one patient who did not have an acromion fracture. However, one patient who did not undergo fixation of the acromion fracture developed osteoarthrosis of the shoulder joint. In this type of fracture, it is important to stabilize the acromion fracture at the same time as fixation of the glenoid fracture.

Ideberg III glenoid fractures are rare and difficult in treating among shoulder fractures. With the development of research, a series of surgical approaches and methods were performed, such as anterior approach, traditional Judet approach, modified Judet approach, combined approach, acromion approach and so on. While these approaches still have some limitations in treatment of Ideberg III glenoid fractures with superior shoulder suspensory complex(SSSC) injury, for extensive soft tissue dissection, unsatisfactory exposure, difficult surgical intervention. In our case with Ideberg III glenoid fracture with acromioclavicular dislocation, superior approach was adopted during treatment of the scapula glenoid fracture and coracoclavicular ligament rupture perfectly. The result was satisfactory in accordance with 92 points by Constant-Murley score. We believe that individualized therapy should depend on the injury types, and superior approach would be a new valuable method for Ideberg III glenoid fractures with SSSC injury.

We present a case of a complex proximal humerus fracture combined with an articular glenoid fracture, in an elderly patient. This is a rare combination of injuries, and its proper treatment is scarcely described in the current literature. Our selected treatment consisted of reverse shoulder arthroplasty combined with glenoid fracture fixation, which has been reported only once in the current literature. At 18 months follow-up we report a result consisting of great pain control, appropriate mobility and functional score, and absence of signs of glenohumeral instability or implant loosening, which is in line with has been previously described. We conclude that this surgical approach is a great alternative to others such as reverse shoulder arthroplasty combined with glenoid grafting, or shoulder hemiarthroplasty.

Introduction: Proximal humeral fracture-dislocations can occur in high-energy traumas. This injury can be accompanied by a glenoid fracture; however, it is a rare type of complex injury in patients aged under 60 years. Materials and methods: A 53-year-old man presented with a three-part fracture-dislocation of the proximal humerus and a severely comminuted glenoid fracture. For the glenohumeral dislocation and proximal humeral fracture, we performed closed reduction using a threaded Steinman pin and fixation with percutaneous cannulated screws. Using arthroscopy, while maintaining humeral traction with the Steinman pin, the intra-articular glenoid fragments were reduced and then fixed with a buttressing headless screw and one suture anchor. After a 6-week immobilization with a shoulder spica cast, rehabilitation was initiated. Results: We confirmed bony union of the fracture sites after 6 months post-surgery. The patient showed excellent clinical outcomes with a nearly full range of motion without instability Conclusions: We reported a successful outcome for a complex proximal humeral fracture involving the glenoid using closed reduction and fixation for the proximal humeral fracture and arthroscopic reduction and fixation for the comminuted anteroinferior glenoid fracture. [ABSTRACT FROM AUTHOR]

Objective: To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation. Methods: From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks，8 weeks，3 months，6 months，1 year after surgery) regularly for at least 1 year. At the follow‐up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed. Results: Of the 15 patients, there are seven cases of men, eight cases of women; aged 22–66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%–47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow‐up was 38.2 months (range, 12–70 months), and one case was lost to follow‐up. With fractures healing well, almost all patients had a good joint function. At the final follow‐up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T11 level; the mean Constant–Murley score was 94.6 points (range, 70–100 points); the mean ASES score was 94.6 points (range, 79–100 points); and the mean VAS score was 0.4 points (range, 0–2 points). No recurrent instability or re‐dislocation occurred. No patient had revision surgery. Conclusion: Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow‐up time of more than 3 years. [ABSTRACT FROM AUTHOR]

Objective: Based on the morphological characteristics of glenoid and greater tuberosity (GT) fractures and the relationship between them, we explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fractures. Methods: From December 2013 to December 2019, we retrospectively reviewed the clinical data of patients who were diagnosed with acute anterior shoulder dislocation associated with glenoid and GT fractures in our hospital. According to the fracture site, a glenoid fracture group and a greater tuberosity fracture (GT) group were established, and the morphological characteristics of both glenoid and GT fractures were measured and statistically analyzed. Results: A total of 41 patients (43 shoulders) met the inclusion criteria (39 unilateral shoulders and 2 bilateral shoulders). The mean age was 50.21 years (range, 22–71 years). A total of 27 shoulder injuries (62.8%) were split GT fractures and 33 shoulder injuries (76.7%) were combined with rotator cuff tears. The mean size of glenoid fragments was 30.16% and the mean displacement was 8.85 mm. The mean size of GT fragments was 28.43 mm. The mean superoinferior and anteroposterior displacements of the GT fragment were 6.77 mm and 4.96 mm, respectively. There was a negative correlation between the size of glenoid and GT fracture fragments (r = −0.64, P < 0.05). The glenoid fragments in the Ideberg type Ia glenoid fracture group were smaller than those in the Ideberg type II glenoid fracture group (28.41% and 40.95%, respectively), while the size of GT fragments in the type Ia group were larger than those in the type II group (29.77 mm and 20.21 mm, respectively) (P < 0.05). The GT fragments in the split GT fracture group were larger than those in the avulsion or depression GT fracture group (33.69 mm, 19.07 mm and 21.12 mm, respectively), while the size of glenoid fragments in the split GT fracture group were smaller than those in the avulsion or depression GT fracture group (23.57%, 41.37%, and 43.42%, respectively) (P < 0.05). As for the displacement direction of GT fragments, depression fractures were mainly inferior displacements, avulsion fractures were mainly anterosuperior displacements, while split fractures were mainly posteroinferior displacements (P < 0.05). Multiple regression analysis suggested that the type and the fragment size of GT fractures have a significant influence on the size of glenoid fragments. Conclusion: Acute anterior shoulder dislocations associated with glenoid and GT fractures are often combined with rotator cuff tears. There is a negative correlation between the size of glenoid and GT fragments, and split GT fractures are most common. Such injuries are highly correlated to the relative spatial location between the GT and the glenoid when the shoulder dislocates. [ABSTRACT FROM AUTHOR]

Different techniques have been described for glenoid fractures, there is still a need for safe and effective agents to promote outcomes. From January 2016 to April 2021, the clinical data of 17 patients with pulley type IA fractures treated by the V-shaped fixation technique under shoulder arthroscopy were retrospectively analyzed. Preoperative X-ray, CT, and MRI examinations were completed. The functional score of the shoulder joint, such as the visual analog scale (VAS), Constant score, and Modified Rowe score, was used to evaluate the preoperative and final follow-up clinical outcomes. The active shoulder range of motion (ROM) was also collected preoperatively and at the final postoperative follow-up. Accordingly, intraoperative and postoperative complications were also observed. The mean follow-up was 49.52 months (16-79 months). The patients' follow-up exams showed that shoulder joint flexion, abduction, external rotation, internal rotation, and pain were not significantly different from those of the contralateral side ( p > .05). The mean Constant score was 83.52 (58-98), and the average Modified Rowe score was 94.29 (70-100). X-ray and CT films of all cases showed good healing without articular depression or steps. Three patients had traumatic arthritis, with VAS <3 pain. No postoperative complications, such as infections, nerve or vessel damage, or suture anchor problems occurred during the follow-up period. Using the Double-pull, V-shaped fixation technique can stabilize the reduction of glenoid fractures while reducing the possibility of bone destruction. It is a good solution and provides an opportunity to treat rotator cuff tears associated with the procedure., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Open reduction–internal fixation via an anterior or posterior approach is a widely used method for treating displaced glenoid fractures. This study aimed to identify the exposure range of the glenoid rim by these 2 approaches (deltopectoral and Judet approaches) and provide reference data for the choice of surgical approach. Twelve cadaveric shoulders were dissected. Both deltopectoral and Judet approaches were performed on each shoulder to mark the glenoid fracture. In addition, the shoulder was disarticulated to record the exposure range of the glenoid rim. For the deltopectoral approach, the range of the exposed glenoid rim was from 5:50 to 11:30, which accounted for about 47.2% of the clock face. For the Judet approach, the range of the exposed glenoid rim was from 1:30 to 6:20, which accounted for about 40.3% of the clock face. Along the inferior glenoid, there was an area of partial overlap for the 2 approaches. The superior glenoid rim located from 11:30 to 1:30 was considered inaccessible, as it could not be exposed by the 2 approaches. Less than 50% of the glenoid rim can be exposed by the deltopectoral or Judet approach. With a single approach, it may be difficult to expose and fix some complex glenoid fractures. The superior part of the glenoid fracture is the non-access area via the deltopectoral or Judet approach. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purposes of this review are to discuss the management of shoulder and elbow fractures in athletes to optimize the return to sport and to highlight treatment impact on the return to play.Recent findings: Fractures of the shoulder and elbow can have profound implications in an athlete career. Recent technique of fractures management trended toward to preserve soft tissue which is critical for an early recovery in athletic population. Arthroscopy presents a strong interest for the treatment of intra-articular fracture, and minimally invasive approach as developed in humeral shaft fracture can be considered to avoid soft tissue damage.Summary: Non-articular, stable, and minimally displaced fractures are mainly treated conservatively. However, we encourage a more aggressive approach in shoulder and elbow injuries in the athletes including minimally invasive and stable fixation to preserve vascularity and muscle environment. [ABSTRACT FROM AUTHOR]

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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Bony deficiency of the anteroinferior glenoid rim as a result of a dislocation can lead to recurrent glenohumeral instability. These lesions, traditionally treated by open techniques, are increasingly being treated arthroscopically as our understanding of the pathophysiology and anatomy of the glenohumeral joint becomes clearer. Different techniques for arthroscopic management have been described and continue to evolve. While the success of the repair is surgeon dependent, the recent advances in arthroscopic shoulder surgery have contributed to the growing acceptance of arthroscopic reconstruction of glenoid bone defects to restore stability. Questions/Purposes: The purpose of this study was to describe arthroscopic surgical management options for patients with glenohumeral osseous lesions and instability. Methods: A comprehensive search of PubMed, Cochrane, and Medline was conducted to identify eligible studies. The reference lists of identified articles were then screened. Both technique articles and long-term outcome studies evaluating arthroscopic management of glenohumeral lesions were included. Results: Studies included for final analysis ranged from Level II to V evidence. Technique articles include suture anchor fixation of associated glenoid rim fractures, arthroscopic reduction and percutaneous fixation of greater tuberosity fractures, arthroscopic filling ('remplissage') of the humeral Hill-Sachs lesion, and an all-arthroscopic Latarjet procedure. The overall redislocation rate varied but was consistently <10% with a low complication rate. Conclusion: Management of glenohumeral instability can be challenging but more recent advances in arthroscopic techniques have provided improved means of treating this diagnosis. This manuscript provides a comprehensive review of the arthroscopic treatment of osseous instability of the shoulder. It provides an in depth look at the various treatment options and describes techniques for each. [ABSTRACT FROM AUTHOR]

Background The longevity of total shoulder replacement is primarily limited by the performance of the ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid component in vivo. Variations in glenoid design (conformity, thickness), biomechanics (joint kinematics), and UHMWPE material selection (sterilization, cross-linking) distinguish total shoulder replacements from hip and knee arthroplasty devices. These variables can lead to severe mechanical failures, including gross fracture. Methods Sixteen retrieved glenoids with severe fracture were analyzed. The explant cohort included 3 material groups (gamma-sterilized Hylamer; gamma-sterilized UHMWPE; and gas plasma–sterilized, remelted, highly cross-linked UHMWPE [HXL]) and a range of conformities (0- to 10-mm radial mismatch). Analysis included fractography (optical and scanning electron microscopy) and Fourier transform infrared spectroscopy for oxidative analysis. Results Fracture primarily occurred along the exterior rim for all 16 explants. Fourier transform infrared analysis and fractography revealed significant oxidative embrittlement for all gamma-sterilized glenoids. Fatigue striations and internal flaws were evident on the fracture surface of the HXL glenoid, with little oxidation detected. Conclusions Fracture initiated at the external rim of all devices. Elevated oxidation levels and visible material distortion for representative gamma-sterilized conventional and Hylamer devices suggest oxidative embrittlement as a driving force for crack inception and subsequent fracture. Brittle fracture of theHXL glenoid resulted from a combination of elevated contact stress due to a nonconforming surface, an internal flaw, and reduced resistance to fatigue crack growth. This demonstrates that glenoid fracture associated with oxidation has not been eliminated with the advent of modern materials (HXL) in the shoulder domain. Level of evidence Basic Science Study; Implant Retrieval Study [ABSTRACT FROM AUTHOR]

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Background There is no consensus on the operative treatment of glenoid fractures. The purpose of this study was to see whether there was a difference between how patients with a glenoid fracture would receive treatment according to theoretical operative indications based on the measurement of computed tomography (CT) scans and radiographs and the treatment they actually received in our institutions. Methods A total of 457 patients with a scapular fracture were treated in two level 1 trauma centres between January 2002 and August 2011. Ninety-eight patients with a glenoid fracture were retrospectively analyzed. Intra-articular gap, medial or lateral (M/L) displacement, angular deformity, and glenopolar angle (GPA) were measured on CT scans or radiographs to determine theoretical indications for operative treatment. Results Twenty-four patients (25%) actually had operative treatment, while 35 patients (36%) fulfilled at least one theoretical criterion to proceed with operative treatment with a medium correlation between theoretical indications for surgery and the actual operative treatment. All the patients with a theoretical indication for surgery had an intra-articular gap with a step-off of >4 mm. A bony Bankart lesion with shoulder dislocation and injury in sports was retained in the best multivariable model as indications for the actual surgery. Conclusion Theoretical guidelines for surgery on glenoid fractures may not have much influence on the current treatment. Level of evidence Therapeutic, level III. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the methods and the outcomes of complex intra-articular glenoid fractures, treated by open reduction and internal fixations. Methods: The outcomes of 11 cases of complex intra-articular glenoid scapular fractures were retrospectively analyzed. The fractures were classified as type IV in five cases, type Va in two and Vb in four cases, according to Ideberg classification system. The mean step or gap between the main articular fragments was 6.3 ± 6.2 (4-25) mm. The fractures were openly reduced through a Judet approach and fixed with reconstructive plates or bands placed on the lateral and medial side of affected scapula, respectively. The main articular fragments were strengthened with a 4.0-mm cannulated screw in five cases. The bone union, the anterior flexion, the external and internal rotation of the shoulders were checked and recorded. The functional outcomes were evaluated using DASH questionnaire, Constant and UCLA shoulder score systems, respectively. Results: 11 patients were followed up with an average of 28.2 ± 12.6 (12-50) months. All the fractures were united smoothly without second intervention. At the latest visiting, the mean anterior flexion of affected shoulder was 157.3 ± 7.37° (range 150°-170°), the mean external rotation of the affected shoulder was 58.2 ± 7.5° (range 50°-70°). When the shoulder in the internal rotation, the extended thumb reached to L4 or L1 or T10 or T7 in one case, to T12 in two cases and to T8 in four cases, respectively, the mean Constant score was 91.7 ± 2.8 (86-96) points. The mean UCLA score was 32.7 ± 1.7 (30-35) points, leading to four cases of excellent and seven cases of good results. The mean DASH score was 7.4 ± 3.3 (3.4-13) points. Conclusion: Good outcomes could be obtained when Ideberg IV and V glenoid fractures were treated by open reduction and internal fixation through a Judet approach. [ABSTRACT FROM AUTHOR]