GLENOID FRACTURES AND RELATED SHOULDER INSTABILITY: OUR EXPERIENCE
GERARDO MAQUIEIRA, ALBERTO SCHNEEBERGER, CHRISTIAN GERBER
Department of Orthopaedics, University of Zurich
Acute glenoid rim fractures after shoulder dislocation often do not cause recurrent instability. To obtain a precise diagnosis of the structural lesion, a CT scan may optimally determine the size of the fracture fragment and a possible anterior glenohumeral subluxation. With a centered glenohumeral joint, conservative treatment always lead to satisfactory results in 10 consecutive patients. All of these shoulders were stable at follow-up with no or only mild pain. Internal fixation of the glenoid rim fragment is only considered if the glenohumeral joint is anteriorly subluxed, i.e. if the humeral head moves together with the fractured fragment. Chronic anterior shoulder instability with a bony Bankart lesion, however, is a different entity. The shoulder is unstable, and stabilization may be required. If the length of the bony defect corresponds at least to half of the greatest width of the glenoid (measured on CT scan), simple soft tissue repair might not be sufficient, but bony reconstruction might be necessary. Twenty-two patients with chronic anterior shoulder instability with significant bony defect have been treated with reconstruction of the defect with an iliac crest graft placed intra-articulary and fixed with 2 screws. All shoulders were stable at follow-up except one with a positive anterior apprehension sign. There was no redislocation. The Constant score averaged 70 (60-80).