Fixation of Glenoid Fractures

Glenoid; Fracture

internal fixation

Scapula fractures are uncommon but make up 3-5% of all shoulder girdle injuries. Moreover, intraarticular glenoid fossa fractures represent only 1% of scapula fractures. They are frequently found with concomitant injuries to chest, head, brachial plexus and humerus. The glenoid is an oval shaped portion on the lateral border of the scapula that articulates with the circular rounded end of the humeral head. Superiorly the glenoid is part of the superior shoulder suspensory complex (SSSC) consisting of superior glenoid, coracoid process, coracoclavicular ligaments, distal end of the clavicle, acromioclavicular joint, coracoacromial ligament and acromial process. Subsequently, stability of the shoulder is a complex mechanism in which muscles, ligamentous and capsular restraints, the labrum and joint vacuum, each play a role depending on position and activity. The history of patients with glenoid fractures will mostly consist of either shoulder dislocation or direct trauma to the humeral head. The affected arm is pseudo-paralysed and supported in adduction and internal rotation. Because of a thick layer of soft tissue, only mild swelling and ecchymosis may be seen . For the diagnosis of scapular injuries X-rays are routinely taken , MSCT scanning , MRI & Nerve conduction velocity may be done. Main parameters defining operative treatment are instability, the articular surface fragment size and the degree of displacement. However, concomitant injuries (e.g. thorax, head, extremity fractures, plexus lesion), age, occupation, level of activity and dominance, play a key role in management.

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