title: Open screw fixation of large anterior glenoid rim fractures: mid- and long-term results in 29 patients.
abstract: The aim of this retrospective study was to analyse the clinical, functional and radiographic outcomes of patients sustaining traumatic anterior dislocations of the shoulder in combination with large anterior glenoid rim fractures, treated by open reduction and internal screw fixation (ORIF). Twenty-nine patients with a mean follow-up of 6.5 years (2.5-12 years) were evaluated clinically using the Constant and DASH scores, radiographs in two planes and isokinetic muscle strength measurement (Biodex 3 PRO). Mean age was 41.6 years (17-68 years). There was no case of postoperative re-dislocation. Eight out of 29 patients (27.5%) underwent revision surgery to remove the screws. The mean age- and gender-adjusted Constant score was 93.3% (range 64-102%), and the mean DASH score was 10.1 points (range 0-71 points). On radiological examination, 6 patients had signs of osteoarthritis: Samilson type I (n = 3) and II (n = 3). Significant differences for maximal strength in external rotation and muscular endurance compared to the unaffected side were found (P < 0.035). Twenty-seven patients (93%) were satisfied or very satisfied with the result after surgery. ORIF seems to be a good treatment option in cases of large glenoid rim fractures to avoid re-dislocation in the mid-term. Prospective randomised studies are necessary to compare these findings with those after non-operative or arthroscopic treatment of these injuries.
authors.affiliation: Orthopaedic Department, Division of Shoulder and Elbow Surgery, University of Heidelberg, Schlierbacher Landstrasse 200 A, Heidelberg 69118, Germany. Patric.Raiss@ok.uni-heidelberg.de
authors.forename: Patric
authors.initials: P
authors.lastname: Raiss
authors.forename: Florian
authors.initials: F
authors.lastname: Baumann
authors.forename: Michael
authors.initials: M
authors.lastname: Akbar
authors.forename: Markus
authors.initials: M
authors.lastname: Rickert
authors.forename: Markus
authors.initials: M
authors.lastname: Loew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D020878:Device Removal; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012399:Rotation; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome