Arthroscopy-Assisted Reduction and Internal Fixation versus Open Reduction and Internal Fixation for Glenoid Fracture with Scapular Involvement: A Retrospective Cohort Study

Abstract

Background: We investigated the superiority of arthroscopy-assisted reduction and internal fixation (ARIF) to open reduction and internal fixation (ORIF) for treating glenoid fracture with scapular involvement. Methods: We retrospectively enrolled patients with glenoid fracture who underwent ARIF or ORIF from 2010–2020. Radiographic outcomes were assessed, and clinical outcomes (active range of motion [ROM], visual analog scale [VAS], Constant, and Disabilities of the Arm, Shoulder and Hand [DASH]) were evaluated 12 months postoperatively. Results: Forty-four patients with Ideberg type II–VI glenoid fractures (ARIF: 20; ORIF: 24; follow-up 12–22 months) were included. Union was achieved in all patients. Active ROM values were comparable between the approaches. Constant and DASH scores were non-significantly better with ARIF (90.9 ± 9.2 vs. 86.6 ± 18.1 [p = 0.341] and 6.8 ± 9.4 vs. 9.3 ± 21.3 [p = 0.626], respectively). However, VAS scores were significantly lower with ARIF (1.5 ± 0.6 vs. 2.7 ± 1.4, p = 0.001). Associated intra-articular lesions (articular depressions [80%], superior labral anterior-posterior tear [20%], labral tears [30%]) were found in most ARIF cases and were repaired during ARIF. Conclusions: For glenoid fracture with scapular involvement, ARIF allows accurate diagnosis of fracture pattern and the management of associated intra-articular lesions, with better pain control outcomes than ORIF. Thus, arthroscopy-assistant surgery should be considered in patient with glenoid fracture.

A novel arthroscopic transosseous suture-button fixation technique for anterior glenoid fractures

“…Interestingly, Scheibel et al also found a high rate of relevant intra-articular concomitant lesions in about 78% of cases. Lin et al found better pain outcomes of arthroscopic treatment compared to open surgery as it enabled accurate management of associated intra-articular lesions that were found in 50% of cases of the arthroscopic group [14]. In the current study, in 13 of 23 patients (57%) relevant concomitant lesions were found intra-articularly requiring arthroscopic treatment.…”

“…Surgical treatment of glenoid fractures remains challenging. Recent evidence has shown that open surgery is associated with higher complication rates and worse clinical outcomes than arthroscopic procedures, probably due to the soft tissue trauma requiring detachment of the subscapularis tendon [4,14].…”

Efficacy analysis of axillary approach in the treatment of Ideberg type I and II scapular glenoid fractures: Case series

“…In China, Professor Tian pioneered anatomical studies and concluded that axillary approach surgery is less invasive, with concealed and beautiful incisions, and can achieve good clinical outcomes. [7] Among the 13 scapular glenoid fractures in this study, Ideberg type Ia scapular glenoid fractures accounted for a relatively large number of 10 cases. Unlike bony Bankart injuries, most of the Ideberg type Ia scapular glenoid fractures involved in this paper are anterior and inferior to the scapular glenoid.…”

“…[6] Professor Tian found that axillary approach surgery for the anterolateral rim of scapular glenoid fractures (mainly Ideberg type Ia) has the advantages of minimal trauma, broad exposure, reliable internal fixation, and concealed appearance. [7] From December 2020 to January 2022, we used the axillary approach to treat 13 patients with scapular glenoid fractures with satisfactory results. This study discussed the curative effect and matters needing attention of this operation through retrospective analysis of the data of this group of patients, as reported as follows.…”

“…Ideberg type I and II scaphoid fractures can be fixed surgically using nails, suture anchor, microplates, and special plates for the axillary approach to fix the fracture. [7] When we use the axillary approach for surgery, the fractured fragments can be nudged directly into place with the attached joint capsule because the direction of displacement of the broken mass is perpendicular to the direction of the operator's view. Temporary fixation is achieved by applying a parallel articular surface vertical fracture line with a Kirschner wire.…”