Open reduction and internal fixation of Ideberg type IA glenoid fractures: Tricks, pearls, and potential pitfalls based on a retrospective cohort of 33 patients focusing on the rehabilitation protocol.

Autor: Giordano V; Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil. v_giordano@me.com.; Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil. v_giordano@me.com., Pires RE; Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil., Labronici PJ; Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil., Vieira I; Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil., de Souza FS; Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil., Sassine TJ; Departamento de Ortopedia, Escola de Medicina, Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil., Mendes AF Jr; Hospital Universitário, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil., Freitas A; HOME, Brasília, DF, Brazil.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2023 Apr; Vol. 33 (3), pp. 571-580. Date of Electronic Publication: 2022 Sep 12.
DOI: 10.1007/s00590-022-03389-7
Abstrakt: Introduction: The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim is to describe the surgical steps for ORIF of anterior and anteroinferior glenoid rim fractures using the anterior axillary approach, describing the tricks, pearls, and pitfalls of this surgical technique.
Methods: A retrospective cohort of skeletally mature patients treated for an anterior glenoid rim fracture carrying > 20% of the glenoid fossa during a 10-year period were operated on using a vertical axillary incision, osteosynthesis with 2.0-mm cortical screws, and labral repair with small diameter metallic anchors and non-absorbable sutures. Rehabilitation began on the first postoperative day, including passive external rotation exercises and active-assisted flexion, adduction, and abduction exercises as tolerated. The exercises are performed with the patient sitting or lying down. Phase 1 is continued for 6-10 weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10 weeks, the fracture and labrum are healed, so phase 2 rehabilitation begins with strengthening and ROM exercises. Radiologic and clinical outcomes, including active range of motion (ROM), glenohumeral stability, and visual analogue scale (VAS) were measured.
Results: About 33 patients (35 fractures) had complete medical records and pre- and post-operative imaging exams available for further analysis regarding the surgical protocol, with a mean of 4.8 years. The mean DASH questionnaire was 3.75 ± 9.0 and the mean CM score was 62.5 ± 0.1. Active flexion and internal rotation were recovered in all patients, while external rotation presented an average loss of 8° (p = 0.12) and abduction of 5° (p = 0.33). The mean VAS was 1.1 ± 0.8. No patient reported major or disabling symptoms, or great difficulty or inability to perform daily or recreational activities. No patient presented residual instability of the glenohumeral joint.
Conclusion: In this retrospective cohort, ORIF using a vertical axillary incision, osteosynthesis with 2.0-mm screws, and labral repair with small diameter metallic anchors and non-absorbable sutures was a safe approach, with a minimal risk of complications and residual instability. The accelerated postoperative rehabilitation protocol, allowing immediate passive external rotation of the operated shoulder, resulted in a non-significant loss of ROM compared to the contralateral side. Therefore, we recommend this management strategy for anterior glenoid rim fractures in patients with unstable shoulder joint after traumatic glenohumeral dislocation.
Level of Evidence Iv: Therapeutic Study (Surgical technique and Retrospective cohort).
(© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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