Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population

The Role of Arthroscopy in Contemporary Glenoid Fossa Fracture Fixation

Glenoid fossa fractures are rare injuries accounting for 10 to 29% of all intra-articular scapula fractures. They are usually the result of high-energy trauma, and concomitant injuries are not uncommon. Patients with glenoid fractures are admitted with shoulder pain and restricted range of motion. Although shoulder plain radiographs could establish the diagnosis, a computed tomography scan is necessary to adequately define the fracture pattern and characteristics. The most commonly used classification system is that of Ideberg (modified by Goss), which includes five glenoid fossa fracture types according to the location, extension, and complexity of the lesion. Articular surface displacement and step-off are the most important factors that should be taken under consideration when deciding for conservative or surgical management. Operative treatment includes open reduction and internal fixation through a posterior or anterior approach depending on fracture morphology and displacement. However, open surgical techniques are related to extensive soft-tissue disruption, risk of neurovascular injury, and inadequate exposure of the entire glenoid cavity. Introduction of arthroscopy could facilitate better visualization of the glenoid articular surface and improved fracture reduction. However, it is a technically demanding procedure with many challenges and pitfalls. The aim of this review is to summarize the current evidence regarding the treatment of glenoid fossa fractures and present the beneficial effect of arthroscopy in improving the quality of fracture fixation and overall functional outcomes.

Three-dimensional morphometric analysis of glenoid in the Indonesian population and its clinical significance

Background

Understanding glenoid morphometry is important in shoulder prosthetic replacement surgery. In total and reverse shoulder arthroplasty, the size of the implants has to be determined according to the morphometry of the shoulder. However, there has been no known data on glenoid morphometry in the Indonesian population.

Methods

Seventy-four computed tomography scans of asymptomatic shoulders were obtained from the medical databases of a third referral hospital in Jakarta. Mimics Research 21.0 was used to reconstruct 3D models of the scapula from the DICOM files. The morphometry parameters included were glenoid fossa height (GFH), maximum glenoid fossa width (MGW), glenoid width at center of the glenoid fossa (CGW), vertical distance between maximum width and center (VDMC), glenoid version angle (GVA), glenoid inclination (GI), glenopolar angle (GPA), glenoid vault depth (GVD), coracoid length (CL), coracoid midpoint length (CML), coracoid tip height (CTH) and width (CTW), and coracoid midpoint height (CMH) and width (CMW).

Results

Our study found the average Indonesian GFH was 30.24 mm, the MGW was 24.03 mm, the CGW was 22.46 mm, the VDMC was 3.67 mm, the GPA was 42.76°, the GVD 18.8 mm, the GVA was 2.39° retroverted, the GI was 3.15° superiorly inclined, the CL was 37.76 mm, the CML was 18.89 mm, the CTW was 13.31 mm, the CTH was 8.52 mm, the CMW was 14.21 mm, and the CMH was 10.46 mm. All parameters except VDMC, GVA, and GI showed significant differences between male and female subjects Meanwhile, there was no significant difference in dimension and orientation of the glenoid and coracoid between the right and left shoulder.

Conclusion

Our study showed a lower value of MGW, GFH, and GVD compared to other Asian ethnicities. These results may be helpful in designing smaller prostheses suitable for Indonesian glenoids.

Glenoid Morphology and Related Parameters in Turkish Society

Introduction

Glenoid morphology may vary in different ethnic groups. Detection of these differences may be important in preoperative planning, especially in reverse shoulder arthroplasty. In this study, we investigated the mean glenoid size and retroversion in Turkish society and their relationship with the dominant side, gender, height, weight, and body mass index (BMI).

Materials and methods

Between 2019 and 2021, 102 shoulders of 51 patients (24 females/27 males, 51 left/51 right) who were included in shoulder joint imaging during thorax CT scanning were examined. Those with glenoid fracture, arthrosis, shoulder surgery or deformity, or younger than 18 years of age were not included in the study. The mean age was 41.69 (range: 18-73) years. Glenoid anterior-posterior diameter (D) and glenoid version (GV) were measured in axial slices, and glenoid height (H) was measured in coronal slices. The correlation of these parameters with gender, height, weight, and dominant side was examined.

Results

Mean D was 25.79±4.44 mm, mean H was 29.08±4.08 mm, and mean GV was -0.99°±0.92°. The mean height of the patients was 162±16.23 cm and the mean weight was 71.9±15.36 kg. The glenoid diameter and height were smaller in females, however, no statistically significant difference was found in the glenoid version (p<0.01, p<0.01, and p=0.92). The glenoid on the dominant side was statistically significantly more retroverted, whereas D and H were not associated with dominance (p<0.01, p=0.9, and p=0.98). It was found that the glenoid sizes were very highly correlated with the patient's height, and it was highly correlated with the patient's weight (p<0.01 and p<0.01). On the other hand, height and weight were not correlated with the glenoid version (p=0.47 and p=0.81, respectively). There was no statistically significant relationship between BMI and glenoid sizes and glenoid version (p=0.14 and p=0.46, respectively).

Conclusions

Females in Turkish society had small glenoid sizes. Male gender, height, and weight were positively correlated with large glenoids. The glenoid was more retroverted on the dominant side. These findings should be considered in preoperative planning in Turkish society.

Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis

PURPOSE

The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations.

METHODS

PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included.

RESULTS

The proportion of Hill-Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill-Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01).

CONCLUSION

Higher proportions of Hill-Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill-Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance.

LEVEL OF EVIDENCE

IV.