Glenoid Neck Fracture
synonyms:
Glenoid Neck Fx ICD-9
Glenoid Neck Fx Etiology / Epidemiology / Natural History
Glenoid Neck Fx Anatomy
- Long head of triceps tendon typically displaces the glenoid inferiorly and laterally.
- Avoid quadrangular space during posterior exposure.
Glenoid Neck Fx Clinical Evaluation
- These are typically high enegery injuries, assessment should begins with the A,B,C's.
- C/O shoulder pain after trauma.
- Evaluate for tenderness, ecchymosis, soft tissue injury.
- Document axillary, median, ulnar, radial nerve function and radial pulse.
Glenoid Neck Fx Xray / Diagnositc Tests
- Grashe view (true A/P of scapula), scapular lateral, axillary view.
- CT scan generally indicated to fully assess fracture.
Glenoid Neck Fx Classification / Treatment
- Nondisplaced / minimally displaced : immobilization in a sling for 1 wk followed by progressive ROM and physical therapy.
- Displaced (displacement >1cm, >40 degrees of angulation in the coronal or sagittal planes): ORIF
Glenoid Neck Fx Technique
- Contraindications: severely comminunted fractures which preclude satisfactory fixation.
- It is important to review scapular anatomy before surgery. Look at a skeleton and review areas in which fixation can be placed in the scapula.
- Consent for iliac crest bone graft if needed.
- Pre-op antibiotics, SCD's on bilateral lower extremities
- General endotracheal anesthesia
- Folley catheter
- Lateral decubitus position; axillary role; pad all bony prominences
- Prep and drap in standard sterile fashion
- Incision over lateral spine of the scapula alone posterior aspect of acromion.
- Expose posterior deltoid and subperiosteally reflect it off its origin from the scapular spine and acromion. This exposes the underlying infraspinatus and teres minor.
- Incise inferior 1/2 of the infraspinatus insertion and open the interval between the infraspinatus and teres minor. This exposes posterior capsule.
- Infraspinatus is reflect of the caspule and retracted superiorly.
- Posterior capsule is incised from the humerus and elcvated superiorly exposing the glenoid. Fukuda retractor can be used to hold humeral head anteriorly.
- Fracture is identified, reduced and fixed using standard AO techniques. Fixation is generally provided with 3.5mm reconstruction plates, and / or 3.5mm or 4.0mm cannulated screws.
- Keep in mind the majority of the scapula is paper thin. Adequate bone stock to hold screws can be found: in the glenoid neck, coracoid process, base of the scapular spine, and lateral border of the scapular body.
- Irrigate
- Close in layers
Glenoid Neck Fx Associated Injuries / Differential Diagnosis
Glenoid Neck Fx Complications
- Nerve injury: axillary
- Glenohumeral arthritis
- Nonunion
- Malunion
- Infection
- Stiffness
Glenoid Neck Fx Follow-up Care
- Shoulder immobilizer with gentle pendulum, elbow/wrist/hand ROM immediately
- F/U at 7-10 days. Start physcial therapy for gentle ROM exercises at first post-op visit.
- ROM and strengthening are advanced dependent on fracture type, fixation and healing. Generally patients remain in the sling for 6 weeks. Has limited use of the extremiity for 10-12 weeks and must refrain from heavy physical activity for 4-6 months.
- Shoulder Outcome measures.
Glenoid Neck Fx Review References
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