Open operative treatment of acute glenoid fractures following anterior and posterior shoulder dislocation

Objective Acute osseous fractures of the glenoid (avulsion of the labrum-ligament-capsule complex including anterior-inferior osseous glenoid lesions as well as fractures of the fossa glenoidalis) need to be regarded as absolute indication for surgery due to the incidence of recurrent dislocations and danger of secondary progressive glenoid defects. As a basic principle of surgery, the bone-labrum-ligament-capsule complex has to be refixated and the osseous geometry reconstructed anatomically. Indications Anterior dislocations: all traumatic dislocations in association with a fossa glenoidalis or glenoid rim defect. Posterior dislocations: all unstable situations with osseous glenoid defects persisting after reposition. Contraindications Brachial plexus injury. Poor glenoid bone stock. Surgical Technique Anterior glenoid defect: exposition of the glenoid through a deltopectoral approach. Fragment refixation depending on fragment size with suture anchor devices or cannulated screws. Posterior glenoid defect: exposition of the glenoid through a modified Brodsky approach from posterolateral. Exposure of the posterior capsule between infraspinatus and teres minor muscles, medial casulotomy. Reposition and refixation of the osseous fragment analogous to anterior lesions. In fractures with glenoid neck or scapular body affection additional fixation and support through plate osteosynthesis at the margo lateralis scapulae. In case of persisting instability reconstruction of the glenoid defect with an autologous graft with or without endoprosthetic glenoid resurfacing is optional. Postoperative Management To preserve reconstructed anatomy, a Gilchrist sling is required for 4-6 weeks after anterior reconstructions. For postoperative treatment of posterior defects, a thorax abduction splint is recommended for 6 weeks. Reduced ROM (range of motion) exercise is provided under physiotherapeutic guidance according to individual pathology. Results Clinical results following open surgery of osseous glenoid lesions are generally very good. In the own patients, an average Constant Score of 88, a Rowe Score of 89, and a Simple Shoulder Test according to Matsen of 85% could be achieved.