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Published in: International Orthopaedics 11/2016

01-11-2016 | Original Paper

Pathoanatomy and computed tomography classification of glenoid fossa fractures based on ninety patients

Authors: Jan Bartoníček, Michal Tuček, Daniel Klika, Antonín Chochola

Published in: International Orthopaedics | Issue 11/2016

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Abstract

Purpose

The aim of the article is to present the pathoanatomy and a new classification of glenoid fractures developed on the basis of analysis of 3D computed tomography (CT) examinations and intra-operative findings.

Materials and methods

The study group comprised 90 patients (69 men and 21 women) who sustained glenoid fractures. Mean patient age was 47 years (17-92). In 77 nonpolytraumatised patients, anteroposterior (AP) radiographs of the affected shoulder girdle were taken, including Neer I and II views. All 90 patients underwent CT examination, combined in 73 of them with 3D CT reconstruction including subtraction of the humeral head, ribs and clavicle, from the anterior and posterolateral views. In total, 52 patients (58 %) were operated on and 38 42 %) were treated non-operatively.

Results

In total, five basic types of injuries to the glenoid were identified based on analysis of the separated portion of the glenoid fossa: including fractures of the superior glenoid (14 cases, 16 %), the anterior glenoid (23 cases, 23 %), the posterior rim of the glenoid (5 cases, 6 %), the inferior glenoid (38 cases, 42 %) and the entire glenoid (10 cases, 11 %).

Conclusion

The proposed classification of glenoid fractures defines five basic types of fractures verified by 3D CT reconstructions and intra-operative findings. It respects the anatomical architecture of scapula, fracture mechanism, associated injuries to the shoulder girdle and, where appropriate, the preferred surgical approach.
Literature
1.
go back to reference Bartoníček J, Kozánek M, Jupiter JB (2016) Early history of scapular fractures. Int Orthop 40:213–222CrossRefPubMed Bartoníček J, Kozánek M, Jupiter JB (2016) Early history of scapular fractures. Int Orthop 40:213–222CrossRefPubMed
2.
go back to reference Hardegger F, Simpson LA, Weber BG (1984) The operative treatment of scapula fractures. J Bone Joint Surg (Br) 66-B:725–731 Hardegger F, Simpson LA, Weber BG (1984) The operative treatment of scapula fractures. J Bone Joint Surg (Br) 66-B:725–731
3.
go back to reference Leung KS, Lam TP, Poon KM (1993) Operative treatment of displaced intra-articular glenoid fractures. Injury 24:324–328CrossRefPubMed Leung KS, Lam TP, Poon KM (1993) Operative treatment of displaced intra-articular glenoid fractures. Injury 24:324–328CrossRefPubMed
4.
go back to reference Hersovici D, Roberts CS (2006) Scapula fractures: to fix or not to fix? J Orthop Trauma 20:227–229CrossRef Hersovici D, Roberts CS (2006) Scapula fractures: to fix or not to fix? J Orthop Trauma 20:227–229CrossRef
5.
go back to reference Zlowodski M, Bhandari M, Zelle BA, Kregor CPA (2006) Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma 20:230–233CrossRef Zlowodski M, Bhandari M, Zelle BA, Kregor CPA (2006) Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma 20:230–233CrossRef
6.
go back to reference Lantry JM, Roberts CS, Giannoudis PV (2008) Operative treatment of scapular fractures: a systematic review. Injury 39:271–283CrossRefPubMed Lantry JM, Roberts CS, Giannoudis PV (2008) Operative treatment of scapular fractures: a systematic review. Injury 39:271–283CrossRefPubMed
7.
go back to reference Mulder FJ, van Suchtelen M, Menedez ME, Gradl G, Neuhas V, Ring D (2015) A comparison of actual and theoretical treatments of glenoid fractures. Injury 46:699–702CrossRefPubMed Mulder FJ, van Suchtelen M, Menedez ME, Gradl G, Neuhas V, Ring D (2015) A comparison of actual and theoretical treatments of glenoid fractures. Injury 46:699–702CrossRefPubMed
8.
go back to reference Bartoníček J (2015) Scapular fractures. In: Court-Brown CH, Heckman AD, McMqQueen, Ricci WM, Torneta P (eds) Rockwood and Green‘s fractures in adults, 8th edn. Wolters Kluwer, Philadelphia, pp 1475–1501 Bartoníček J (2015) Scapular fractures. In: Court-Brown CH, Heckman AD, McMqQueen, Ricci WM, Torneta P (eds) Rockwood and Green‘s fractures in adults, 8th edn. Wolters Kluwer, Philadelphia, pp 1475–1501
9.
go back to reference Ideberg R (1984) Fractures of the scapula involving glenoid fossa. In: Bateeman JE, Welsh RP (eds) Surgery of the shoulder. Decker, Philadelphia, p 63 Ideberg R (1984) Fractures of the scapula involving glenoid fossa. In: Bateeman JE, Welsh RP (eds) Surgery of the shoulder. Decker, Philadelphia, p 63
10.
go back to reference Ideberg R, Grevsten S, Larsson S (1995) Epidemiology of scapula fractures. Acta Orthop Scand 66:395–397CrossRefPubMed Ideberg R, Grevsten S, Larsson S (1995) Epidemiology of scapula fractures. Acta Orthop Scand 66:395–397CrossRefPubMed
11.
go back to reference Goss TP (1992) Fractures of the glenoid cavity. J Bone Joint Surg Am 74-A:299–305 Goss TP (1992) Fractures of the glenoid cavity. J Bone Joint Surg Am 74-A:299–305
12.
go back to reference Goss TP (2004) Fractures of the scapula. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB (eds) The shoulder, 3rd edn. Saunders, Philadelphia, pp 413–454 Goss TP (2004) Fractures of the scapula. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB (eds) The shoulder, 3rd edn. Saunders, Philadelphia, pp 413–454
13.
go back to reference Mayo KA, Benirschke SK, Mast JW (1998) Displaced fractures of the glenoid fossa. Clin Orthop Rel Res 346:122–130 Mayo KA, Benirschke SK, Mast JW (1998) Displaced fractures of the glenoid fossa. Clin Orthop Rel Res 346:122–130
14.
go back to reference Orthopaedic Trauma Association (1996) Fracture and dislocation compendium. Scapula fractures. J Orthop Trauma (Suppl 1):S81-4 Orthopaedic Trauma Association (1996) Fracture and dislocation compendium. Scapula fractures. J Orthop Trauma (Suppl 1):S81-4
15.
go back to reference Orthopaedic Trauma Association (2007) Fracture and dislocation compendium. Scapula fractures. J Orthop Trauma (Suppl 1):S68-71 Orthopaedic Trauma Association (2007) Fracture and dislocation compendium. Scapula fractures. J Orthop Trauma (Suppl 1):S68-71
16.
go back to reference Jaeger M, Lambert S, Südkamp NP, Kellam JF, Madsen JR, Babst R, Andermahr J, Li W, Audigé L (2013) The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapular fracture classification system: focus on glenoid fossa involvement. J Shoulder Elbow Surg 22:512–520CrossRefPubMed Jaeger M, Lambert S, Südkamp NP, Kellam JF, Madsen JR, Babst R, Andermahr J, Li W, Audigé L (2013) The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapular fracture classification system: focus on glenoid fossa involvement. J Shoulder Elbow Surg 22:512–520CrossRefPubMed
17.
go back to reference ter Meulen DP, Janssen SJ, Hageman MGJS, Ring DC (2016) Quantitative three-dimensional computed tomography analysis of glenoid fracture patterns according to the AO/OTA classification. J Shoulder Elbow Surg 25:269–275 ter Meulen DP, Janssen SJ, Hageman MGJS, Ring DC (2016) Quantitative three-dimensional computed tomography analysis of glenoid fracture patterns according to the AO/OTA classification. J Shoulder Elbow Surg 25:269–275
18.
go back to reference Tuček M, Bartoníček J, Frič V (2011) Osseous anatomy of scapula: its importance for classification of scapular body fractures. Ortopedie (Czech Orthopaedics) 5:104–109 Tuček M, Bartoníček J, Frič V (2011) Osseous anatomy of scapula: its importance for classification of scapular body fractures. Ortopedie (Czech Orthopaedics) 5:104–109
19.
go back to reference Chochola A, Tuček M, Bartoníček J, Klika D (2013) CT-diagnosis of scapular fractures. Rozhl Chir 92:385–388PubMed Chochola A, Tuček M, Bartoníček J, Klika D (2013) CT-diagnosis of scapular fractures. Rozhl Chir 92:385–388PubMed
20.
go back to reference Schandelmaier P, Blauth M, Schneider C, Krettek C (2002) Fractures of the glenoid treated by operation. J Bone Joint Surg (Br) 84-B:173–177CrossRef Schandelmaier P, Blauth M, Schneider C, Krettek C (2002) Fractures of the glenoid treated by operation. J Bone Joint Surg (Br) 84-B:173–177CrossRef
21.
go back to reference Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR (2009) Acromioclavicular and sternoclavicular injuries and clavicular, glenoid and scapular fractures. J Bone Joint Surg Am 91-A:2492–2510 Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR (2009) Acromioclavicular and sternoclavicular injuries and clavicular, glenoid and scapular fractures. J Bone Joint Surg Am 91-A:2492–2510
22.
go back to reference Lewis S, Argintar E, Jahn R, Zusmanovich M, Itamura J, Hatch GFR (2013) Intra-articular scapular fractures: outcomes after internal fixation. J Orthop 10:188–192CrossRefPubMedPubMedCentral Lewis S, Argintar E, Jahn R, Zusmanovich M, Itamura J, Hatch GFR (2013) Intra-articular scapular fractures: outcomes after internal fixation. J Orthop 10:188–192CrossRefPubMedPubMedCentral
23.
go back to reference Nork SE, Barei DP, Gardner MJ, Schildhauer TA, Mayo KA, Bernischke SK (2008) Surgical exposure and fixatiuon of displaced type IV, V, and VI glenoid fractures. J Orthop Trauma 22:487–493CrossRefPubMed Nork SE, Barei DP, Gardner MJ, Schildhauer TA, Mayo KA, Bernischke SK (2008) Surgical exposure and fixatiuon of displaced type IV, V, and VI glenoid fractures. J Orthop Trauma 22:487–493CrossRefPubMed
24.
go back to reference Euler E, Habermeyer P, Kohler W, Schweiberer L (1992) Skapulafrakturen - Klassifikation und Differentialtherapie. Orthopade 21:158–162PubMed Euler E, Habermeyer P, Kohler W, Schweiberer L (1992) Skapulafrakturen - Klassifikation und Differentialtherapie. Orthopade 21:158–162PubMed
25.
go back to reference Euler E, Rüedi T (1996) Scapulafraktur. In: Habermeyer P, Schweiber L (eds) Schulterchirurgie. Urban und Schwarzenberg, München, pp 261–271 Euler E, Rüedi T (1996) Scapulafraktur. In: Habermeyer P, Schweiber L (eds) Schulterchirurgie. Urban und Schwarzenberg, München, pp 261–271
26.
go back to reference Wiedemann E (2004) Frakturen der Skapula. Unfallchirurg 107:1124–1133 Wiedemann E (2004) Frakturen der Skapula. Unfallchirurg 107:1124–1133
27.
go back to reference McAdams TR, Blevins FT, Martin TP, DeCoster TA (2002) The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma 16:7–11CrossRefPubMed McAdams TR, Blevins FT, Martin TP, DeCoster TA (2002) The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma 16:7–11CrossRefPubMed
28.
go back to reference Bartoníček J, Frič V, Tuček M (2009) Radiographic evaluation of scapular fractures. Rozhl Chir 88:84–88PubMed Bartoníček J, Frič V, Tuček M (2009) Radiographic evaluation of scapular fractures. Rozhl Chir 88:84–88PubMed
29.
go back to reference Ada JR, Miller ME (1991) Scapula fractures. Analysis of 113 cases. Clin Ortop Rel Res 269:174–180 Ada JR, Miller ME (1991) Scapula fractures. Analysis of 113 cases. Clin Ortop Rel Res 269:174–180
30.
go back to reference Adam FF (2002) Surgical treatment of displaced fractures of the glenoid cavity. Inter Orthop (SICOT) 26:150–153CrossRef Adam FF (2002) Surgical treatment of displaced fractures of the glenoid cavity. Inter Orthop (SICOT) 26:150–153CrossRef
31.
go back to reference Scheibel M, Magosch P, Lichtenberg S, Habermeyer P (2004) Open reconstruction of anterior glenoid rim fractures. Knee Surg Sports Traumatol Arthrosc 12:568–573CrossRefPubMed Scheibel M, Magosch P, Lichtenberg S, Habermeyer P (2004) Open reconstruction of anterior glenoid rim fractures. Knee Surg Sports Traumatol Arthrosc 12:568–573CrossRefPubMed
32.
go back to reference Tauber M, Moursy M, Eppel M, Koller H, Resch H (2008) Arthroscopic screw fixation of large anterior glenoid fractures. Knee Surg Sports Traumatol Arthrosc 16:326–332CrossRefPubMed Tauber M, Moursy M, Eppel M, Koller H, Resch H (2008) Arthroscopic screw fixation of large anterior glenoid fractures. Knee Surg Sports Traumatol Arthrosc 16:326–332CrossRefPubMed
33.
go back to reference Osti M, Gohm A, Benedetto KP (2009) Results of open reconstruction of anterior glenoid rim fractures following shoulder dislocation. Arch Orthop Trauma Surg 129:1245–1249CrossRefPubMed Osti M, Gohm A, Benedetto KP (2009) Results of open reconstruction of anterior glenoid rim fractures following shoulder dislocation. Arch Orthop Trauma Surg 129:1245–1249CrossRefPubMed
34.
go back to reference Anavian J, Gauger EM, Schroder LK, Wijdicks CA, Cole PA (2012) Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures. J Bone Joint Surg Am 94:645–653CrossRefPubMed Anavian J, Gauger EM, Schroder LK, Wijdicks CA, Cole PA (2012) Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures. J Bone Joint Surg Am 94:645–653CrossRefPubMed
35.
go back to reference Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, Cole PA (2009) Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am 91-A:2222–2228CrossRef Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, Cole PA (2009) Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am 91-A:2222–2228CrossRef
36.
go back to reference Bartoníček J, Tuček M, Frič V, Obruba P (2014) Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop 38:2163–2173CrossRefPubMed Bartoníček J, Tuček M, Frič V, Obruba P (2014) Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop 38:2163–2173CrossRefPubMed
37.
go back to reference Wu J, Fu XJ, Sha M, Liu H, Chen ZD, Kang LQ (2016) Treating Eyres type IV and V coracoid fracture using the acromion osteotomy approach. Int Orthop 40:377–384 Wu J, Fu XJ, Sha M, Liu H, Chen ZD, Kang LQ (2016) Treating Eyres type IV and V coracoid fracture using the acromion osteotomy approach. Int Orthop 40:377–384
38.
go back to reference Cole PA (2006) Scapular fractures: open reduction internal fixation. In: Wiss DA (ed) Master techniques in orthopaedic surgery. Lippincot Williams and Wilkins, Philadelphia, pp 15–36 Cole PA (2006) Scapular fractures: open reduction internal fixation. In: Wiss DA (ed) Master techniques in orthopaedic surgery. Lippincot Williams and Wilkins, Philadelphia, pp 15–36
39.
go back to reference Cole PA, Marek DJ (2007) Shoulder girdle injuries. In: Standard JP, Schmidt AH, Gregor PJ (eds) Surgical treatment of orthopaedic trauma. Thieme, New York, pp 207–237 Cole PA, Marek DJ (2007) Shoulder girdle injuries. In: Standard JP, Schmidt AH, Gregor PJ (eds) Surgical treatment of orthopaedic trauma. Thieme, New York, pp 207–237
40.
go back to reference Cole PA, Gauger EM, Schroder LK (2012) Management of scapular fractures. J Am Acad Orthop Surg 20:130–141CrossRefPubMed Cole PA, Gauger EM, Schroder LK (2012) Management of scapular fractures. J Am Acad Orthop Surg 20:130–141CrossRefPubMed
41.
go back to reference Bauer T, Abadie O, Hardy P (2006) Arthroscopic treatment of glenoid fractures. J Arthrosc Rel Surg 22:569e1–569e6CrossRef Bauer T, Abadie O, Hardy P (2006) Arthroscopic treatment of glenoid fractures. J Arthrosc Rel Surg 22:569e1–569e6CrossRef
42.
go back to reference Sugaya H, Kon Y, Tsuchiaya A (2005) Arthroscopic repair of glenoid fractures using suture anchors. J Arthrosc Rel Surg 21:635e1–635e5 Sugaya H, Kon Y, Tsuchiaya A (2005) Arthroscopic repair of glenoid fractures using suture anchors. J Arthrosc Rel Surg 21:635e1–635e5
44.
go back to reference Maquieira GJ, Espinosa N, Gerber C, Eid K (2007) nonoperative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder. J Bone Joint Surg (Br) 89-B:1347–1351CrossRef Maquieira GJ, Espinosa N, Gerber C, Eid K (2007) nonoperative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder. J Bone Joint Surg (Br) 89-B:1347–1351CrossRef
45.
go back to reference Christensen TJ, Kubiak EN (2014) Epidemiology, clinical evaluation, imaging and classification of scapular fractures. In: Iannotti JP, Miniaci A, Williams GR, Zuckerman JD (eds) Disorders of the shoulder, diagnosis and management: shoulder trauma, 3rd edn. Wolter Kluwer, Philadelphia, pp 153–166 Christensen TJ, Kubiak EN (2014) Epidemiology, clinical evaluation, imaging and classification of scapular fractures. In: Iannotti JP, Miniaci A, Williams GR, Zuckerman JD (eds) Disorders of the shoulder, diagnosis and management: shoulder trauma, 3rd edn. Wolter Kluwer, Philadelphia, pp 153–166
Metadata
Title
Pathoanatomy and computed tomography classification of glenoid fossa fractures based on ninety patients
Authors
Jan Bartoníček
Michal Tuček
Daniel Klika
Antonín Chochola
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 11/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-016-3169-4

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