Glenoid Neck Fracture S42.153A 811.03

Glenoid bone anatomy

Scapular bone anatomy

shoulder cross section

synonyms: glenoid neck fracture, scapular neck fracture

Glenoid Neck Fracture ICD-10

A -   initial encounter for closed fracture

B -   initial encounter for open fracture

D -  subsequent encounter for fracture with routine healing

G -  subsequent encounter for fracture with delayed healing

K -   subsequent encounter for fracture with nonunion

P -  subsequent encounter for fracture with malunion

S -  sequela

Glenoid Neck Fracture ICD-9

  • 811.03 Fracture of scapula, closed: glenoid cavity and neck of scapula

Glenoid Neck Fracture Etiology / Epidemiology / Natural History

Glenoid Neck Fracture Anatomy

  • Long head of triceps tendon typically displaces the glenoid inferiorly and laterally.
  • Avoid quadrangular space during posterior exposure.

Glenoid Neck Fracture Clinical Evaluation

  • These are typically high enegery injuries, assessment should begins with the A,B,C's.
  • C/O shoulder pain after trauma.
  • Evaluate for tenderness, ecchymosis, soft tissue injury.
  • Document axillary, median, ulnar, radial nerve function and radial pulse.

Glenoid Neck Fracture Xray / Diagnositc Tests

  • Grashe view (true A/P of scapula), scapular lateral, axillary view.
  • CT scan generally indicated to fully assess fracture.

Glenoid Neck Fracture Classification / Treatment

  • Nondisplaced / minimally displaced : immobilization in a sling for 1 wk followed by progressive ROM and physical therapy.
  • Displaced (displacement >1cm, >40 degrees of angulation in the coronal or sagittal planes): ORIF

Glenoid Neck Fracture Technique

  • Contraindications: severely comminunted fractures which preclude satisfactory fixation.
  • It is important to review scapular anatomy before surgery. Look at a skeleton and review areas in which fixation can be placed in the scapula.
  • Consent for iliac crest bone graft if needed.
  • Pre-op antibiotics, SCD's on bilateral lower extremities
  • General endotracheal anesthesia
  • Folley catheter
  • Lateral decubitus position; axillary role; pad all bony prominences
  • Prep and drap in standard sterile fashion
  • Incision over lateral spine of the scapula alone posterior aspect of acromion.
  • Expose posterior deltoid and subperiosteally reflect it off its origin from the scapular spine and acromion. This exposes the underlying infraspinatus and teres minor.
  • Incise inferior 1/2 of the infraspinatus insertion and open the interval between the infraspinatus and teres minor. This exposes posterior capsule.
  • Infraspinatus is reflect of the caspule and retracted superiorly.
  • Posterior capsule is incised from the humerus and elcvated superiorly exposing the glenoid. Fukuda retractor can be used to hold humeral head anteriorly.
  • Fracture is identified, reduced and fixed using standard AO techniques. Fixation is generally provided with 3.5mm reconstruction plates, and / or 3.5mm or 4.0mm cannulated screws.
  • Keep in mind the majority of the scapula is paper thin. Adequate bone stock to hold screws can be found: in the glenoid neck, coracoid process, base of the scapular spine, and lateral border of the scapular body.
  • Irrigate
  • Close in layers

Glenoid Neck Fracture Associated Injuries / Differential Diagnosis

  • >80% incidence of associated injury
  • Rib fracture, pulmonary contusion
  • Clavicle Fracture
  • Proximal Humerus Fracture
  • Scapular Fracture
  • Acromioclavicular dislocation
  • Sternoclavicular dislocation
  • Scapulthoracic dissociation
  • Floating Shoulder

Glenoid Neck Fracture Complications

  • Nerve injury: axillary
  • Glenohumeral arthritis
  • Nonunion
  • Malunion
  • Infection
  • Stiffness

Glenoid Neck Fracture Follow-up Care

  • Shoulder immobilizer with gentle pendulum, elbow/wrist/hand ROM immediately
  • F/U at 7-10 days. Start physcial therapy for gentle ROM exercises at first post-op visit.
  • ROM and strengthening are advanced dependent on fracture type, fixation and healing. Generally patients remain in the sling for 6 weeks. Has limited use of the extremiity for 10-12 weeks and must refrain from heavy physical activity for 4-6 months.
  • Shoulder Outcome measures.

Glenoid Neck Fracture Review References

  • Goss JAAOS 3:22;1995
  • Ada JR, CORR 1991;269:174
  • Goss TP, JSES 1994;3:42
  • Wirth MA, in Complex and Revision Problems in Shoulder Surgery, 2005. ISBN-10: 0781746582
  • Rockwood and Green's Fractures in Adults 6th ed, 2006
  • OKU - Shoulder and Elbow 2nd ed, 2002