You are here

Glenoid Neck Fracture S42.153A 811.03

synonyms: glenoid neck fracture, scapular neck fracture

Glenoid Neck Fracture ICD-10

A -   initial encounter for closed fracture

B -   initial encounter for open fracture

D -  subsequent encounter for fracture with routine healing

G -  subsequent encounter for fracture with delayed healing

K -   subsequent encounter for fracture with nonunion

P -  subsequent encounter for fracture with malunion

S -  sequela

Glenoid Neck Fracture ICD-9

  • 811.03 Fracture of scapula, closed: glenoid cavity and neck of scapula

Glenoid Neck Fracture Etiology / Epidemiology / Natural History

Glenoid Neck Fracture Anatomy

  • Long head of triceps tendon typically displaces the glenoid inferiorly and laterally.
  • Avoid quadrangular space during posterior exposure.

Glenoid Neck Fracture 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 Fracture Xray / Diagnositc Tests

  • Grashe view (true A/P of scapula), scapular lateral, axillary view.
  • CT scan generally indicated to fully assess fracture.

Glenoid Neck Fracture 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 Fracture 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 Fracture Associated Injuries / Differential Diagnosis

Glenoid Neck Fracture Complications

  • Nerve injury: axillary
  • Glenohumeral arthritis
  • Nonunion
  • Malunion
  • Infection
  • Stiffness

Glenoid Neck Fracture 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 Fracture Review References

 

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer