Glenoid fractures are rare shoulder fractures, especially when combined with Acromion Fractures. This PPT presents one such case and dual approach for treatment

1. Rare Scapular Injuries
Chirag V Thakkar MS (Ortho), F.KUMC (Seoul)
Associate Professor, GMERS Medical College,
Vadodara, Gujarat, India

2. Acromial Fractures
 Classification:
Type 1- Undisplaced
Type 11- Minimal displacement with no
Subacromial Impingement
(Inferior Displacement X)
Type 111- Displaced with subacromial space
reduction (Impingement of RC Tendons)

3. Acromial Fractures
Kuhn’s Classification

4. Acromial Fracture Treatment
Type 111 Acromion Process fracture
causing impingement of the RC
Tendons

5. Acromial Fracture Treatment
 Type 1- Mostly Conservative
 Type 11- CC Screws, TBW, K wiring
 Type 111- Plating, CC screws, May
require open reduction

6. Acromial Fracture Treatment
Plate
fixation
Plate Fixation

7. Acromial Fracture Treatment
CC Screw
Fixation

8. Acromial Fracture Treatment
TBW Fixation

9. Glenoid Fractures
 Classification Description
 Type 1a Anterior rim
 Type 1b Posterior rim
 Type 2 Transverse to lateral margin
 Type 3 Transverse to superior margin
 Type 4 Transverse to medial margin
 Type 5a Transverse lateromedial
 Type 5b Transverse superomedial
 Type 5c Transverse
superomediolateral
 Type 6 Comminuted

10. Glenoid Fractures
 Classification Description
 Type 1a Anterior rim
 Type 1b Posterior rim
 Type 2 Transverse to lateral margin
 Type 3 Transverse to superior margin
 Type 4 Transverse to medial margin
 Type 5a Transverse lateromedial
 Type 5b Transverse superomedial
 Type 5c Transverse
superomediolateral
 Type 6 Comminuted

11. Glenoid Fractures

12. Glenoid Fractures
Type 111 and Vb are most difficult to treat- Approach?, Fixation?

13. Glenoid Fracture Treatment
CC Screw
Fixation

14. Glenoid Fracture Treatment

15. Glenoid Fracture Treatment
Superior Border of Scapula not aligned
well

16. Glenoid Fracture Treatment
Superior Border of Scapula not aligned
well

17. Glenoid Fracture Treatment
 Limitations: Exposure- Anterior/Posterior
 Posterior- Lateral margin Involvement
(Types 11, 1V, Va and Vc)
 Anterior- Anterior Rim (Preferred
A’scopy)
- Displaced Types 111 and Vb
• Relative Indications of Glenoid Fixation-
• >20* angulation, >5mm articular step-off and
>20 % anterior glenoid involvement with GH
instability, GPA < 20*

18. Rare Scapular # - Glenoid +
Acromion
 Patient Profile-
◦ Age- 57 years
◦ Profession- Job and light work
◦ Co-morbidities- Diabetes and Hypertension
◦ Mode of Trauma- Direct Blow with a bat in a
public transport vehicle bout
• Challenges- Diabetes, Treatment Options,
Fixation Methods, Approach to the Shoulder

19. Rare Scapular # - Glenoid +
Acromion

20. Rare Scapular # - Glenoid +
Acromion
Acromion- Type 3, Glenoid-
Type 3

21. Rare Scapular # - Glenoid +
Acromion

22. Rare Scapular # - Glenoid +
Acromion

23. Rare Scapular # - Glenoid +
Acromion
Acromion #
Exposed

24. Rare Scapular # - Glenoid +
Acromion
Superior Direct Acromial
Approach

25. Rare Scapular # - Glenoid +
Acromion
Osteotomised Lesser
Tub.
Glenoid Fracture
Exposed

26. Rare Scapular # - Glenoid +
Acromion
Inferior Capsule
Coinjoined
Tendon
Coracoid
Osteotomised
LT

27. Rare Scapular # - Glenoid +
Acromion
K wire
Joysticks
Osteotomised LT
Long Biceps
Tendon

28. Rare Scapular # - Glenoid +
Acromion

29. Rare Scapular # - Glenoid +
Acromion
Immediate Post Operative
Radiographs

30. Rare Scapular # - Glenoid +
Acromion
Immediate Post operative
Radiographs

31. Rare Scapular # - Glenoid +
Acromion
Video demo-
Repaired LT
osteotomy
(Subscap) with 4
mm CC screws, the
Biceps Pulley
examination and
Fixation of Glenoid
with anterior plate.
Sutured Rotator
Cuff Interval is seen
superiorly

32. Rare Scapular # - Glenoid +
Acromion
Results At 4 Months
Abduction- Only terminal restriction of
10*
Forward Flexion- Upto 160*
Ext Rotation- +40*
Internal Rotation- Full
DASH Score- 12

33. Rare Scapular # - Glenoid +
Acromion
United #s of Acromion and
Glenoid. United osteotomy of LT

34. Rare Scapular # - Glenoid +
Acromion
 Special Instruments required on Table
◦ Fukuda’s Humeral Head Retractors
◦ Shanz pins/ Threaded K wires
◦ Delicate thin Hoffman’s retractors
◦ Osteotomes
◦ Angulated/ Regular bone saw with thin
blades
◦ Suture anchors and mini fragment plates

35. Rare Scapular # - Glenoid +
Acromion
 Lessons Learned from this case
◦ Fixation of Glenoid could be (?) tried from
the superior Acromial approach using
Acromial # and splitting Rotator cuff
interval from the bursal side
◦ Glenoid # could have been left alone and
treated conservatively- debate goes on
◦ Early physio rehab and Diabetic control
really helps in achieving good results

36. Rare Scapular Injuries
Chirag V Thakkar MS (Ortho), F.KUMC
(Seoul)
Associate Professor, GMERS Medical
College,
Vadodara, Gujarat, India
THANK YOU