67 Arthroscopic Reduction and Internal Fixation of Glenoid Rim Fractures

10.1055/b-0039-167716

67 Arthroscopic Reduction and Internal Fixation of Glenoid Rim Fractures

Devin R. Mangold, Joshua S. Dines, Jonathan D. Barlow, and Christopher L. Camp

Abstract

The goal of this arthroscopic approach is to obtain anatomic reduction of intra-articular glenoid fractures with labral suture anchors and rigid fixation with an extra-articular screw. Arthroscopic treatment of glenoid fractures minimizes the morbidity associated with traditional open approaches including infection, neurovascular injury, subscapularis injury, decreased postoperative motion, and a prolonged recovery. This technique can be used for simple intra-articular fractures of the glenoid when the fracture fragment can be mobilized and reduced by arthroscopic means.

67.1 Goals of Procedure

Although intra-articular glenoid fractures are an uncommon injury, they can have important implications for shoulder stability and chondral preservation. While surgical stabilization is typically recommended, fixation can be technically challenging. Traditional open exposures used to treat intra-articular glenoid fractures are associated with significant morbidity, and intra-articular reduction and is frequently compromised. Accordingly, the goal of this arthroscopic approach is to obtain anatomic reduction of intra-articular glenoid fractures while reducing the morbidity associated with an open approach.

67.2 Advantages

Arthroscopic treatment of glenoid fractures minimizes the morbidity associated with traditional open approaches including infection, neurovascular injury, subscapularis injury, decreased postoperative motion, and prolonged recovery. Additionally, through an indirect reduction technique by achieving labral fixation, there is less need for provisional fixation with K-wires and reduction clamps, thereby lowering the risk of damage to neurovascular structures. Additionally, rigid fixation with an extra-articular screw offers superior stability compared to techniques utilizing suture anchors alone. Finally, intra-articular visualization is enhanced via an arthroscopic approach.

67.3 Indications

This technique can be used for simple intra-articular fractures of the glenoid when the fracture fragment can be mobilized and reduced by arthroscopic means.

67.4 Contraindications

This technique is not suited for complex, comminuted fractures or when anatomic reduction cannot be achieved arthroscopically. Additionally, this method requires an intact labrum and soft-tissue connection between the labrum and the fracture fragment.

67.4.1 Preoperative Preparation/positioning

Standard radiographs and CT scans are essential to adequately understand the fracture morphology ( Fig. 67.1 ). 3D reconstructions can be particularly helpful to appreciate the nature of the fracture. MRI may also be helpful in identifying concomitant pathology.

**Fig. 67.1** Anteroposterior (*left*) X-ray, axillary X-ray (*top right*), and axial CT (*bottom right*) demonstrating intra-articular glenoid fracture involving the anterior glenoid.

After anesthesia is administered, an examination of the shoulder under anesthesia should be performed in order to gain a better sense of the magnitude of instability associated with the injury. Afterward the patient is placed in the lateral decubitus position on a beanbag and 10 to 15 lb of traction is applied to the extremity during the operation. Alternatively, the procedure may be performed in the standard beach-chair position. Intraoperative fluoroscopy is required for confirmation of safe placement of the extra-articular screw.

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