Glenoid fracture

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Classification according to ICD-10
S42.1 Fracture of the scapula
S42.14 Glenoid Cavitas
ICD-10 online (WHO version 2019)

A glenoid fracture is a fracture of the shoulder socket ( cavitas glenoidalis ), which is part of the shoulder blade . If the entire shoulder socket is separated from the shoulder blade and intact, there is a scapular neck fracture (collum fracture), which does not extend into the joint ( extra-articular ). The glenoid fracture itself is always intra-articular. When classifying glenoid fractures, two forms can be distinguished: the break at the edge of the socket and that of the entire shoulder socket.

While fractures of the shoulder blade are rare, accounting for 0.4–1% of all bone fractures, only about 10% of these are glenoid fractures and only one tenth of these are significantly displaced so that surgery is necessary. Of all glenoid fractures, 75–85% are acetabular or osseous avulsions at the anterior acetabular edge as a result of shoulder dislocation .

Broken pan rim

Cup rim fractures are almost always the result of shoulder dislocation and correspond to bony tears in the joint capsule. A typical example and the most common glenoid fracture is the bony Bankart lesion , which describes the bony tear at the anterior edge of the acetabulum with anterior shoulder dislocation. When the edge of the acetabulum is broken off, the joint lip ( glenoid labrum ) is always torn and usually the joint capsule is torn as well. Chronic instability of the glenohumeral joint can result without surgical fixation of the torn socket rim . Refixation is usually carried out using small fragment lag screws through an anterior or posterior surgical approach.

Fracture of the entire glenoid

Right glenoid fracture with accompanying clavicle fracture
Left glenoid fracture, osteosynthetically treated
Isolated left glenoid fracture

A glenoid fracture that affects the entire shoulder socket, on the other hand, is usually caused by an accident mechanism with a very high impact energy, for example in a traffic accident. Accompanying injuries to the collarbone, chest, arm plexus and cervical spine are not uncommon. Computed tomography is usually essential for an accurate diagnosis . If the fragments are displaced by 3 mm or more, surgical repositioning and osteosynthesis are indicated in order to avoid premature osteoarthritis due to the uncorrected intra-articular step formation. The fixation is usually done with sutures, wires, screws or plates, which are inserted either by means of an arthroscopic or an open operation.

Most of the time the fracture heals without any major restriction of movement, in 75% good results are achieved. The risk of shoulder osteoarthritis depends on the size of the cartilage damage and the quality of the surgical reconstruction. During the operation there is also a considerable risk of injuring important nerves and vessels. To avoid stiffening of the shoulder due to shrinkage of the joint capsule, early physiotherapy exercises are necessary.

Scapular neck

Scapular hernias must also be surgically repositioned and fixed if the glenoid is clearly displaced or tilted. As a result of the pull of the long tendon of the triceps brachii muscle , the glenoid often slips down ( caudally ) and tilts. In Skapulahalsbrüchen there is also the increased risk of injury to the by the close to scapulae notch extending suprascapular nerve , which only in the electromyogram is detectable.

See also

Web links

Commons : Scapula Fractures  - Collection of pictures, videos, and audio files

Individual evidence

  1. ↑ E. Euler, P. Habermeyer, W. Kohler, L. Schweiberer : Scapular fractures - classification and differential therapy. In: The orthopedist. Volume 21, Number 2, April 1992, pp. 158-162, ISSN  0085-4530 . PMID 1594236 .
  2. ↑ Stephan Coenen, Frank Hoffmann, Bernhard Weigel: Scapular fractures (Chapter 5.3) in the shoulder section in: Bernhard Weigel, Michael Nerlich (eds.): Praxisbuch Unfallchirurgie. Springer-Verlag Berlin 2005, Volume 1, ISBN 3-540-41115-1 , pp. 261-264.
  3. ↑ Dirk PH van Oostveen, Olivier PP Temmerman, Bart J. Burger and others: Glenoid fractures: A review of pathology, classification, treatment and results. In: Acta Orthopædica Belgica. 2014, Volume 1 from March 2014, pp. 8–98.
  4. ↑ B. Karitzky: Shoulder blade fractures . In: H. Bürkle de la Camp, M. Schwaiger: Handbook of the entire accident medicine. 3rd volume, Enke Verlag, 1965, pp. 28-33.
  5. ↑ R.-P. Meyer, F. Moro, H.-K. Schwyzer, BR Simmen: Traumatology to the shoulder girdle: 54 instructive cases. 1st edition. Springer Verlag, 2011, ISBN 978-3-642-21817-0 .