Glenoid fractures: a review of pathology, classification, treatment and results.

Glenoid fractures are rare, and relatively little is known about their mechanism, fracture pattern and optimal treatment strategies. The avulsions and rim fractures are strongly associated with anterior shoulder dislocations. Fossa fractures are mostly seen in high energy trauma patients as direct impact of the humeral head against the glenoid fossa. CT-scanning can be very useful in diagnosing the extend of injury and relation of humeral head with the main fragment of the glenoid. Fracture classification systems, have been designed mainly based on trauma mechanism, location and severity of fracture pattern. Treatment depends on instability, the degree of displacement and the articular surface fragment size, but is conservative in most cases. Due to the increase of arthroscopic fixation possibilities, operative treatment may increase. In this review, we have tried to summarize the available evidence into a treatment algorithm for different types of glenoid fractures. With regard to best functional outcome, an anatomical and concentric joint restoration should be the goal of treatment. Outcome is generally good in conservative and operative treatment, but exact data is difficult to appreciate, due to heterogeneity and comorbidities in different studies.

Suture anchors are superior to transglenoid sutures in arthroscopic shoulder stabilization.

PURPOSE: We retrospectively compared 2 groups of high-demand patients with post-traumatic anterior shoulder instability to determine whether arthroscopic stabilization was superior with transglenoid suture or suture anchors. METHODS: In a retrospective comparative study we investigated the results of 246 high-demand patients, with post-traumatic anterior shoulder instability, who underwent arthroscopic capsulolabral reconstruction: 165 (mean age, 27.5 years; mean follow-up, 80 months) were evaluated after treatment with transglenoid sutures, and 81 (mean age, 26.6 years; mean follow-up, 27 months) were treated with suture anchors in a consecutive period. We compared both techniques with regard to recurrence rate, postoperative complications, range of motion, sport activity, work, and patient satisfaction. RESULTS: In the anchor group recurrent dislocation after surgery occurred in 7 patients (8.7%), all within 18 months postoperatively. This finding was significantly (P = .009) better than that in the transglenoid group, in which recurrent postoperative dislocation occurred in 57 patients (34%), in a period of 0 to 115 months after surgery. Postoperative complications were seen in 4 of 81 patients in the suture anchor group, whereas a significantly (P = .01) higher rate was found in the transglenoid suture group, with 36 complications in 35 of 165 patients. CONCLUSIONS: The data presented in this study suggest that the modern suture anchor technique results in a better outcome after shoulder stabilization, with fewer complications and lower recurrence rates, than the transglenoid repair. We conclude that the suture anchor technique should be a preferred method for arthroscopic shoulder stabilization surgery. LEVEL OF EVIDENCE: Level III, retrospective, comparative therapeutic study.