Summary

Anteroinferior axillary approach is easy, minimally invasive, and appears to be a highly useful approach to treat glenoid rim fracture (Ideberg Type-Ia).

Abstract

Introduction

Glenoid fossa fractures are relatively rare, accounting for 0.1% of all fractures. The Ideberg classification is often used to classify fracture types, and it has been reported that anterior rim of the scapular glenoid fossa fractures (Ideberg Type Ia) account for approximately 8% of scapular fractures.
Open reduction and internal fixation through the deltopectoral approach or arthroscopic fixation is commonly used for the surgical treatment of glenoid rim fracture. This study introduces a novel surgical approach, anteroinferior axillary approach for the treatment of anterior glenoid rim fracture with preliminary results of 8 cases.

Methods

We studied 8 patients with acute anterior glenoid rim fracture from April 2020 to March 2024. Exclusion criteria were cases with old fractures and proximal humerus fractures requiring open reduction and internal fixation with plates or nails.
Patients were placed in supine position with upper extremity in abduction and external rotation. By this positioning, the axillary neurovascular bundle (Axillary artery and vein, axillary nerve, musculocutaneous nerve, median nerve, radial nerve, ulnar nerve) is allowed to escape superior. A small skin incision (2-3cm) was made anteroinferior axillary along the Langer’s line. The soft tissue was bluntly dissected to reach the glenoid rim. Under fluoroscopic guidance, the fragment was reduced and fixated by a 4.0-mm cannulated screw with a spike washer using a 10-cc syringe with both ends cut off as a guide sleeve to prevent the entrapment of the neurovascular bundle. The shoulder was immobilized for 3 weeks using a sling, The passive range of motion exercise was started 3 weeks after surgery.

Results

We treated 8 cases with glenoid rim fracture through anteroinferior axillary approach. The mean age was 65.8 (46-87) years. Body Mass Index is 30.4 (23.6-36.6). All fractures were classified as Ideberg Type-Ia. The average bone fragment size was 37.1% (28.4-43.6%) of the glenoid width. Operating time averaged 45.8 (35-70) minutes with minimal blood loss. Rehabilitation was completed on average 6 months （3-8 months）after surgery. The final active shoulder range of motion improved to 148 ˚ in flexion, 147 ˚ in abduction, 58 ˚ in external rotation at the side, and T11 in internal rotation behind the back postoperatively. All cases achieved bone union and recovered the ability to perform daily activities after surgery.

Conclusions

Anteroinferior axillary approach is easy, minimally invasive, and appears to be a highly useful approach to treat glenoid rim fracture (Ideberg Type-Ia). With optimal positioning of the limb and the use of guide sleeve, surgeons can treat the glenoid rim fracture without any damage to the neurovascular bundle.