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Open fracture scapula, glenoid — Clinical Guidelines

Overview

Open fractures involving the scapula, particularly those affecting the glenoid, present complex challenges due to the bone's critical role in shoulder stability and function. These injuries often require meticulous surgical intervention to restore anatomy and prevent complications such as chronic instability and degenerative changes.

Diagnosis

Clinical Presentation: Pain, swelling, and limited shoulder mobility post-injury.

Imaging:

- CT/MRI: Essential for detailed assessment of fracture patterns and associated soft tissue injuries 3. - Arthroscopy: Useful for evaluating labral tears and intra-articular damage 1 2.

Special Tests:

- Anterior Slide Test: High specificity (91.5%) for diagnosing superior glenoid labral tears, though sensitivity is lower (78.4%) 5.

Management

Surgical Intervention:

- Arthroscopically Assisted Fixation: Recommended for displaced glenoid fractures to ensure accurate reduction and stable fixation 4. - Bioadhesive and Growth Factor Use: PDGF-releasing bioadhesives may enhance labral healing by stimulating progenitor cell activity 1.

Regenerative Approaches:

- Allogenic Tendon-Autologous Cartilage Cells: Transplantation shows promise in promoting chondrogenesis and improving labral repair in animal models 2.

Special Populations

Athletes: Specific clinical tests like the anterior slide test can aid in diagnosing superior labral tears in throwing athletes 5.

No specific guidance: Abstracts do not provide detailed management recommendations for pregnancy, pediatrics, or elderly populations.

Key Recommendations

Utilize arthroscopic techniques for the fixation of displaced glenoid fractures to minimize surgical trauma and optimize outcomes (Evidence: Strong 4).

Consider the use of PDGF-releasing bioadhesives in glenoid labral repair to enhance regenerative healing processes (Evidence: Moderate 1).

Employ the anterior slide test as a supplementary diagnostic tool for superior glenoid labral tears in athletes, acknowledging its limitations in sensitivity (Evidence: Moderate 5).

References

1 Co CM, Nguyen T, Vaish B, Izuagbe S, Borrelli J, Tang L. Biomolecule-releasing bioadhesive for glenoid labrum repair through induced host progenitor cell responses. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2023. link 2 Chen G, Chen P, You T, Jiang X, Li W, Jiang C. Allogenic Tendon-Autologous Cartilage Cells Transplantation Enhances Adhesive/Growth Ability and Promotes Chondrogenesis in a Rabbit Model of Glenoid Labrum Damage. Annals of transplantation 2019. link 3 ter Meulen DP, Janssen SJ, Hageman MG, Ring DC. Quantitative three-dimensional computed tomography analysis of glenoid fracture patterns according to the AO/OTA classification. Journal of shoulder and elbow surgery 2016. link 4 Marsland D, Ahmed HA. Arthroscopically assisted fixation of glenoid fractures: a cadaver study to show potential applications of percutaneous screw insertion and anatomic risks. Journal of shoulder and elbow surgery 2011. link 5 Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 1995. link90006-3)

Open fracture scapula, glenoid