Arthroscopic-assisted Treatment of Glenoid Fractures in Conjunction With High-grade Acromioclavicular Joint Injury

Abstract

Complex shoulder fractures, with lesions in different parts of the shoulder girdle, are a challenging pathology for diagnosis, classification, and treatment. In this technical note we present 2 cases of such complex fractures. We discuss the difficulty of classifying these types of lesions. Although most classification systems focus on 1 element of the shoulder girdle, we underline the need of a system that describes the shoulder girdle as a whole and that allows to classify the magnitude of injury types of these complex structures, addressing both the scapula and the superior shoulder suspensory complex. We present a stepwise surgical approach for the complex combination of a glenoid fracture and a high-grade acromioclavicular luxation. It is a rare surgical setup combining open and arthroscopic techniques to receive an anatomic reduction.S capular fractures are uncommon. They account for only 1% of all fractures, 3% of all shoulder-girdle injuries, and 5% of all shoulder fractures. 1 The scapular body and spine are involved in approximately 50% of all the scapular fractures, with the remainder involving the glenoid cavity [approximately 10% (Goss 1 ) to 38% (Jaeger et al 2 )], the glenoid neck (approximately 25%), and fractures of the acromial and coracoid processes (approximately 7% each). 1 Diagnosis depends mainly on radiographic examinations of the shoulder. When the glenoid is involved, additional imaging by 3-dimensional computed tomography (3D-CT) scan is strongly recommended to accurately analyze the glenoid surface. Treatment modalities of scapular fractures depend on the fracture's location, pattern, and displacement on the one hand and the patient's age, demands, and comorbidity on the other. 1 In contrast to fractures of the scapular body, which are mostly treated conservatively, fractures involving the glenoid are more often in need for surgery. 2 This is because this type of scapula fracture can result in joint instability and implies a risk of posttraumatic arthrosis accompanied by pain and limited function. 2 Classification of scapular fractures can be useful for documentation and uniformity between series, and also for a systematic approach and management of these fractures. A number of scapular fracture classification systems are available. 1-7 A comprehensive scapula classification system has recently been developed as a collaborative effort between the AO Foundation and the Orthopaedic Trauma Association. 2 However, analyzing a combined trauma of a scapular fracture with a lesion of the superior shoulder suspensory complex (SSSC) becomes more difficult.In this technical note we describe our approach in 2 cases of combined scapular fractures. Diagnosis was obtained by performing CT scanning with 3-dimensional reconstructions. This surgical treatment consists of a new stepwise approach, effectively combining different surgical techniques. To obtain a stable result with optimal joint surface congruity, we use both minimal invasive and arthroscopic techniques for reduction and fixation of the gl...

Prebending of osteosynthesis plate using 3D printed models to treat symptomatic os acromiale and acromial fracture

“…Anterior fixation was achieved using six angle-stable screws (10 or 12 mm). The coracoid fracture was treated percutaneously with a hollow screw as described by Hillewaere and Dierickx ( 2014 ), with the exception that in our case radioscopic rather than arthroscopic monitoring of the reduction was used. After surgery, the patient was advised to stop smoking to avoid impairing the healing process.…”

“…Classification of these fractures using current systems is very difficult. Indications for operative management include symptomatic non-union, displaced fractures or acromion fractures associated with other lesions of the superior shoulder suspensory complex (Hillewaere and Dierickx, 2014 ).…”