Fractures

Abstract

Arthroscopic techniques are rarely used in the treatment of shoulder fractures. However, arthroscopy may be beneficial in some cases of greater tuberosity fracture, coracoid fracture, fracture of the glenoid rim, and displaced intra-articular humeral head malunion. These procedures can be technically demanding and are best used to address small fractures.

Keywords

fracture, glenoid, greater tuberosity, coracoid, internal fixation

Arthroscopic techniques are rarely used in the treatment of shoulder fractures. However, arthroscopy may be beneficial in some cases of greater tuberosity fracture, coracoid fracture, fracture of the glenoid rim, and displaced intra-articular humeral head malunion. These procedures can be technically demanding and are best used to address small fractures ( Fig. 17.1 ).

Literature Review

The majority of fracture cases involve glenoid rim fractures (see Fig. 17.1 ). Smaller fragments are incorporated with suture fixation during a Bankart repair, and larger fragments can be fixed with cannulated screws. Hardy (see ) from France has had good experience in the management of glenoid fractures arthroscopically. Acute greater tuberosity fractures occur both with and without glenohumeral dislocation; the association between greater tuberosity fracture and acute anterior–inferior glenohumeral dislocation is well known. Operative treatment for displaced greater tuberosity fractures using an open surgical approach has been well described. However, there are fewer reports on arthroscopic management.

Diagnosis

Radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) can all be used alone or in combination to make these diagnoses ( Fig. 17.2 ).

Nonoperative Treatment

Nonoperative treatment is the mainstay for nondisplaced greater tuberosity fractures and for almost all fractures with less than 5 mm of displacement. In older patients who sustain a greater tuberosity or glenoid fracture associated with a dislocation, despite imperfect healing radiographically, they generally do heal. Stiffness, rather than recurrent instability, is the biggest issue. Glenoid fractures in this population involving as much as 15% to 20% of the glenoid can be managed nonoperatively with acceptable outcomes. Minimally displaced fractures of the greater tuberosity managed nonoperatively will often heal as a malunion with acceptable active and passive motion ( Figs. 17.3–17.5 ).