Objective
Boney Bankart injuries with a fragment from the anterior rim of the glenoid are not the most frequent ones after an anterior shoulder dislocation but can cause severe impairment of the joint and residual instability directly related with the amount of bone avulsed. Different treatment options have been described including fixation or reconstruction of the glenoid bone using distal tibia allograft. The primary objective of this study is to analyze and compare clinical outcomes, Western Ontario Shoulder Instability (WOSI) scores, complication, and re-dislocation rates.
Methods
This study included patients who underwent arthroscopic surgery for glenoid fracture between 2012-2020. Patients were included if they sustained a type Ia glenoid fracture according to Ideberg-Goss classification and if they were treated arthroscopically within three months of injury with one of two surgical techniques; Fixation (including fracture fragment reduction and fixation with screws, buttons, or sutures and anchors), and glenoid reconstruction. Patients were excluded if they had concomitant fractures to ipsilateral humerus or clavicle during injury and history of ipsilateral shoulder instability. Demographic information, WOSI scores, and complications related to the surgery, or new dislocation events were recorded.
Results
Thirty-eight patients were included with both the fixation and reconstruction groups had similar demographics and baseline characteristics, except for the percentage of patients with comminution which was higher in the reconstruction group (p=0.04) (Table 1). Both the fixation and reconstruction groups has similar pre- and post-operative glenoid AP measurements (Table 1). Patient-reported outcomes were similar post-operatively between the two groups (p=0.546) (Figure 1).
Conclusions
Arthroscopic glenoid fracture fixation has good outcomes but concerns exist regarding cartilage damage. Complex comminuted fracture patterns are suitable for reconstruction with patients achieving comparable outcomes to those who undergo fracture fixation.