Arthroscopic Reconstruction of Multifragmented Anteroinferior Glenoid Rim Fractures.

BACKGROUND: The optimal treatment of anteroinferior glenoid rim fractures remains a matter of debate. Surgical repair aims to prevent persistent instability and osteoarthritic changes of the glenohumeral joint1-3 and is recommended in patients with a subluxated humeral head and substantial displacement of the fracture fragment(s)3-5. Arthroscopic reconstruction with suture anchors was described by Sugaya et al. for large solitary glenoid rim fractures using an indirect reduction and fixation via labral repair6. We present the arthroscopic reconstruction of a multifragmented anteroinferior glenoid rim fracture using a modified knotless anchor technique and bioabsorbable pins. The additional fixation and compression may improve reduction and consolidation of the fracture. DESCRIPTION: The patient is placed in the lateral decubitus position with the affected arm fixed in a traction device. A standard posterior, an anterosuperior (suprabicipital), and a deep anteroinferior portal are required for this minimally invasive technique. A posterolateral portal may be required additionally. First, a diagnostic arthroscopy is performed to identify possible concomitant lesions. Labral repair enables an indirect reduction of the attached fracture fragments and is achieved by the aid of knotless suture anchors. Temporary reduction using Kirschner wires can be applied. Bioabsorbable pins can be used for additional ultimate fixation and compression of the fracture fragments. ALTERNATIVES: A variety of surgical techniques for the reconstruction of glenoid rim fractures have been described in the literature, including open or arthroscopic screw osteosynthesis using either metallic or bioabsorbable screws3,6-10. Screw osteosynthesis, however, is not a feasible option for fractures with multiple small fragments3. Isolated suture anchor reconstruction represents another alternative6. Good clinical results and a high subjective satisfaction rate, however, can also be achieved by nonoperative treatment, depending on the patient and fracture characteristics3,10-12. RATIONALE: This minimally invasive technique enables an almost anatomical reconstruction of the glenoid rim with a minor risk of hardware impingement compared with screw osteosynthesis.