Glenoid & Scapula Fractures

Glenoid Fractures

 

Indications for Surgery

 

ORIF

- > 5mm step

- > 1/4 glenoid rim and displaced

 

Ideberg Classification Intra Articular Fracture

 

Type I

 

Fractures of the Glenoid rim

I A anterior 

I B posterior

 

Differentiate from small bony Bankart

- ORIF if > 1/4th or > 10 mm displaced (Neer)

 

Case 1

 

Glenoid Rim Fracture 1Glenoid Rim Fracture 2Glenoid Rim Fracture 2Glenoid Rim ORIF

 

Case 2

 

Glenoid FractureGlenoid Fracture CTGlenoid Fracture CT 2Glenoid ORIF

 

Case 3

 

Scapular fracture intraarticular glenoid axialScapula ORIF APScapula ORIF Lateral

 

Case 4

 

Glenoid Frac APGlenoid Frac AxialGlenoid Fracture CT

 

Type II

 

Transverse fracture through glenoid fossa

- inferior triangular fragment 

- exits lateral border scapula

 

Glenoid FractureGlenoid ORIF

 

Scapula Fracture XrayScapula Fracture Intra articular CT SagittalScapula Fracture Intra articular Glenoid Coronal CT

 

Glenoid Fracture 1Glenoid Fracture 2Glenoid Fracture 3

 

Type III

 

Oblique fracture through the glenoid    

- exiting through superior border of the scapula

- associated with AC fracture or ACJ dislocation

- includes the Coracoid

 

Type IV

 

Similar to II, larger superior fragment

- horizontal

- exiting thru the medial border of the blade

 

Glenoid FractureGlenoid Fracture 2Glenoid Fracture 3

 

Glenoid ORIFGlenoid ORIF 2Glenoid ORIF 3

 

Type V

 

Combination

- Va =IV+II

- Vb=IV+III

- Vc=IV+III+II

 

Type VI

 

Extensive comminution

 

Glenoid Malunion

 

Case 1

- untreated glenoid rim fracture

- patient with chronic instability

- treated with glenoid osteotomy

 

Glenoid Fracture Malunion CTGlenoid Osteotomy APGlenoid Osteotomy Lateral

 

Scapular Fractures

 

A.  Body

 

Often don't need ORIF
- well splinted by fascia / haematoma

- can treat non operatively

 

Scapula Body FractureScapular Body Fracture CT

 

Scapular Blade Fracture CTScapular Blade Fracture CT 2

 

Indications for surgery

- > 45 degrees of angulation of body

 

Scapular Body /> 45 degrees

 

B.  Neck

 

Indications for surgery

- > 450 angulation

- > 10 mm displaced (i.e. medial displacement

 

Case 1

- > 1 cm medial displacement

- ORIF via posterior / modified Judet approach

 

Scapula Neck FractureGlenoid Neck Fracture

 

Scapula ORIFScapula ORIF 3

 

Case 2

 

Glenoid DisplacementGlenoid Displacement CT

 

Glenoid ORIF 1Glenoid ORIF 2

 

C.  Spine

 

Scapula Blade Fracture CTScapula Spine Fracture

 

 

D.  Acromion

 

Spine scapula fracture

 

E.  Coracoid

 

Coracoid Fracture 1Coracoid Fracture 2

 

Coracoid Fracture CT 1Coracoid Fracture CT 2Coracoid Fracture CT 3Coracoid Fracture CT 4

 

Combined Glenoid and Scapula Fractures

 

Case 1

- displaced glenoid fracture and neck fracture

- ORIF both through posterior / Judet approach

 

Glenoid Scapular FractureComplex Scapular Fracture CT 1Complex Scapular Fracture CT2Complex Scapular ORIF