Arthroscopic Management of Glenoid and Greater Tuberosity Bipolar Fractures.

Objective: To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation.

Methods: From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks，8 weeks，3 months，6 months，1 year after surgery) regularly for at least 1 year. At the follow-up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed.

Results: Of the 15 patients, there are seven cases of men, eight cases of women; aged 22-66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%-47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow-up was 38.2 months (range, 12-70 months), and one case was lost to follow-up. With fractures healing well, almost all patients had a good joint function. At the final follow-up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T level; the mean Constant-Murley score was 94.6 points (range, 70-100 points); the mean ASES score was 94.6 points (range, 79-100 points); and the mean VAS score was 0.4 points (range, 0-2 points). No recurrent instability or re-dislocation occurred. No patient had revision surgery.

Conclusion: Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow-up time of more than 3 years.