Session V - Upper Extremity

1.5 - 23 Year Follow-Up of 25 Operated Intra-Articular Scapula Fractures

Peter Schandelmaier, MD, Michael Blauth, Prof., MD, Christian Krettek, Prof., MD, Claus Schneider, Harald Tscherne, Prof., MD

Hannover Medical School, Hannover, Germany

Displaced fractures of the glenoid fossa are rare. The functional results of operative treatment of this injury is unknown since no previous study has addressed this problem.

Between 1973 and 1995, 25 glenoid fractures (type 09-B2 and 09-B3, OTA classification) (22 male, 3 female) were treated by osteosynthesis using plates and screws. All of these fractures had intraarticular displacement. All patients were personally examined at 1.5 to 23 yrs. postoperatively at their own home or in the office. The CONSTANT shoulder score was used for evaluation.

An additional clavicula fracture was present in 4 cases, fracture of the coracoid process in 2 and of the acromion in 4 cases. Twelve patients had sustained a B2 fracture, 13 a B3 fracture. Four cases had an incomplete brachial plexus lesion. A ventral approach was used in 7 cases, in 18 cases a dorsal approach was used. In 8 cases only screws were used for fixation, in 11 cases we used a single plate, in 5 cases two plates were used and in 1 case four plates were used for fixation. Average operative time was 177 min (Range 100 - 300 min.). An anatomic reduction could be accomplished in 20 cases. The average age was 44 yrs. Postoperatively there was implant loosening in two cases, one of them had a reoperation, deep wound infection with involvement of the glenohumeral joint developed in two cases.

The average follow up time was 8.6 years, 12/25 cases were followed for more than 10 years, 20/25 cases had a CONSTANT SCORE of more than 75 / 100. The average score was 86 ± 27. A poor result was present in 4 cases. One case had persistent deficit due to injury to the brachial plexus. Three cases had an active abduction and forward flexion of less than 110°, 2 cases had limited internal rotation of 50° points. Ten patients rated their shoulder function as normal compared to the uninjured side. Five patients had signs of arthritis. Five patients had to change their employment due to shoulder problems. Two patients were using NSAR due to their shoulder, both had pain in the night.

Glenoid fractures with intraarticular displacement are rare. By ORIF of these fractures a good motion and strength without pain can be expected. If brachial plexus injury is present, it determines the functional result. The incidence of postoperative arthritis is low.