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

Abstract

Background: To investigate the clinical efficacy of the axillary approach in the surgical treatment of Ideberg type I and II scapular glenoid fractures. Methods: Retrospective analysis of 13 cases of scapular glenoid fracture treated in the affiliated Hospital of Jining Medical College, Jiaxiang County People hospital, Zoucheng City people Hospital, Yanzhou District People Hospital, and Juancheng County people Hospital from December 2020 to January 2022. Eight males (including one bilateral) and five females, with an average age of 57.5 years (range from 33 to 75 years). According to Ideberg classification, there were 10 cases of type Ⅰ a, 1 case of type Ⅰ a combined with type Ⅰ b, and 2 cases of type Ⅱ. All patients were treated with axillary approach surgery and seven patients with combined anterior shoulder dislocation were treated by first-stage manipulation and second-stage reoperation. Seven patients were fixed with a wire anchor, three patients with type Ⅰ a were fixed with a "T" plate, and five patients were complicated with rotator cuff tear and were repaired with a wire anchor. At the last follow-up, the Constant-Murley shoulder function score, visual analog score (VAS), DASH score, and Hawkins grade were used to evaluate shoulder function, pain, and stability after treatment. Results: All 13 patients in this group were followed up thoroughly, and the follow-up time was 12-25 months, with an average of 18.6 months. The operation time was 65-135min, with an average of 85.6 min. Intraoperative blood loss ranged from 20 to 120mL, averaging 55.6ml. The duration of hospitalization ranged from 7 to 22 days, with an average of 9.6 days. The surgical incisions of all patients were grade-A healing. Bone healing of glenoid fractures was observed three months after the operation. At the last follow-up, the shoulder range of motion was forward flexion 160.5°±9.3°, abduction 155.6°±12.5°, external rotation (neutral position) 40.7°±5.8°, internal rotation (neutral position) 65.4°±12.1°. The Constant-Murley score for the shoulder joint was (92.3±6.5) points (range 85-95), and the DASH score was (12.16±6.86) points (range 3.26 to 26.75). Conclusions: The axillary approach for Ideberg type I and II scapular glenoid fractures is a feasible surgical approach with complete access through the muscle gap, minimal surgical trauma, mild postoperative pain, and satisfactory clinical results.