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Pathological fracture - shoulder — Clinical Guidelines

Overview

Pathological fractures of the shoulder, particularly involving the scapula glenoid or greater tuberosity, often result from underlying bone pathology and can complicate diagnosis and treatment, requiring precise surgical techniques for optimal outcomes. 1 2 3

Diagnosis

Key Diagnostic Criteria: Radiographic imaging (X-ray) is initial but may miss occult fractures; CT and MRI are crucial for detailed assessment and identifying associated rotator cuff injuries. 3

Recommended Tests:

- X-ray for initial screening. - CT for fracture characterization and healing assessment. - MRI to evaluate rotator cuff integrity and soft tissue injuries. 3

Grading: Fractures are often classified based on displacement and comminution, with specific types like Ideberg type Ia for scapular glenoid fractures. 1

Management

First-Line Treatments:

- Conservative management for minimally displaced or occult fractures without significant rotator cuff involvement. 3 - Arthroscopic double-row suture anchor fixation for minimally displaced greater tuberosity fractures and scapular glenoid fractures (Ideberg type Ia). 1 2

Adjunctive Treatments:

- Debridement of fracture surfaces via arthroscopy. - Use of medial and lateral row anchors for anatomical repair and stability. 2

Special Populations

Pediatrics: Not specifically addressed in provided abstracts.

Elderly: Considerations for surgical complexity and healing may apply but are not detailed in the abstracts.

Comorbidities: No specific guidance provided for patients with comorbidities; individualized assessment is recommended. 1 2 3

Key Recommendations

Utilize advanced imaging (CT, MRI) to accurately diagnose occult fractures and associated rotator cuff injuries, avoiding unnecessary surgical interventions. (Evidence: Moderate) 3

For minimally displaced greater tuberosity fractures and scapular glenoid fractures (Ideberg type Ia), arthroscopic double-row suture anchor fixation offers effective repair and functional restoration. (Evidence: Moderate) 1 2

Conservative management is appropriate for one-part greater tuberosity fractures without significant rotator cuff pathology identified on imaging. (Evidence: Weak) 3

References

1 Wang Y, Li Q, Zhang Q. Modified Double-Row and Double-Pulley Technique for the Treatment of Type Ia Scapular Glenoid Fractures. Orthopaedic surgery 2022. link 2 Ji JH, Kim WY, Ra KH. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2007. link 3 Mason BJ, Kier R, Bindleglass DF. Occult fractures of the greater tuberosity of the humerus: radiographic and MR imaging findings. AJR. American journal of roentgenology 1999. link

Pathological fracture - shoulder