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Stammer AT, Saxena P, Dekker AP, Ashwood N. Glenoid Fracture Fixation Using an Acu-Loc Distal Radius Plate. Cureus 2024; 16:e60751. [PMID: 38903285 PMCID: PMC11188009 DOI: 10.7759/cureus.60751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Displaced fractures of the glenoid require surgical fixation. This poses multiple problems, including a difficult approach and achieving adequate reduction with current implants. We provide a surgical technical tip for fixing scapula neck and glenoid rim fractures with an Acu-Loc distal radius plate (Acumed, Weyhill, UK), illustrated with two recent case reports. Here, we present two cases of a 58-year-old female and a 51-year-old male presenting to a hospital following a fall, both sustaining an isolated right glenoid intra-articular fracture evident on plain radiographs. CT scans revealed a displaced and fragmented glenoid surface. A reverse Judet posterior approach facilitated exposure to enable the reduction of the glenoid, an uncommon approach. Current plate designs provide surgeons with limited options to fix complex fractures of the scapula and were not suitable here. The lateral scapula border and inferior glenoid have a similar anatomical shape to the distal radius. An Acu-Loc locking distal radius plate with a radial styloid plate was trialled and provided a good reduction to the fragmented glenoid. A distal radius plate can be a useful option to consider in complex scapula neck and glenoid rim fractures. A better understanding of glenoid shape will facilitate the further development of orthopaedic implants. Familiarity with various surgical approaches is needed to operate on these complex fractures.
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Affiliation(s)
- Adam T Stammer
- Orthopaedic Surgery, Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
| | - Prateek Saxena
- Orthopaedic Surgery, Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
| | - Andrew P Dekker
- Trauma and Orthopaedic Surgery, Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
| | - Neil Ashwood
- Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
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Brahmbhatt PS, Otto RJ. Atraumatic scapular body fractures after reverse total shoulder arthroplasty: a case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:253-260. [PMID: 38706673 PMCID: PMC11065732 DOI: 10.1016/j.xrrt.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Purav S. Brahmbhatt
- Department of Orthopedic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Randall J. Otto
- Department of Orthopedic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
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Chalidis B, Papadopoulos PP, Papadopoulos P, Pitsilos C. The Role of Arthroscopy in Contemporary Glenoid Fossa Fracture Fixation. Diagnostics (Basel) 2024; 14:908. [PMID: 38732322 PMCID: PMC11083719 DOI: 10.3390/diagnostics14090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
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.
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Affiliation(s)
- Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Polychronis P. Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
| | - Charalampos Pitsilos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
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Flaaten N, Moslim H, Tang E, Varrall R. Scapular fractures: A regional and rural perspective. Aust J Rural Health 2024; 32:388-393. [PMID: 38480988 DOI: 10.1111/ajr.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective. OBJECTIVE The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre. DESIGN The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries. FINDINGS One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma. DISCUSSION A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world. CONCLUSION Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.
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Affiliation(s)
- Nordan Flaaten
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopedic Department, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Huissan Moslim
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Eric Tang
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Ruth Varrall
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
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张 剑, 刘 晖, 徐 维, 熊 远, 张 金, 吴 进. [Treatment of Ideberg type Ⅱ scapular glenoid fracture with compression screw combined with Buttress plate through direct axillary approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1375-1379. [PMID: 37987047 PMCID: PMC10662403 DOI: 10.7507/1002-1892.202308005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/03/2023] [Indexed: 11/22/2023]
Abstract
Objective To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡ scapular glenoid fractures. Methods A retrospective analysis was conducted on 11 patients with Ideberg type Ⅱ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function. Results The operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient's shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation ( P<0.05). Conclusion Compression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeⅡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.
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Affiliation(s)
- 剑平 张
- 中国人民解放军联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科(福建漳州 363000)Department of Orthopaedics, Joint Support Force 909th Hospital of Chinese PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian, 363000,P. R. China
| | - 晖 刘
- 中国人民解放军联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科(福建漳州 363000)Department of Orthopaedics, Joint Support Force 909th Hospital of Chinese PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian, 363000,P. R. China
| | - 维臻 徐
- 中国人民解放军联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科(福建漳州 363000)Department of Orthopaedics, Joint Support Force 909th Hospital of Chinese PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian, 363000,P. R. China
| | - 远飞 熊
- 中国人民解放军联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科(福建漳州 363000)Department of Orthopaedics, Joint Support Force 909th Hospital of Chinese PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian, 363000,P. R. China
| | - 金辉 张
- 中国人民解放军联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科(福建漳州 363000)Department of Orthopaedics, Joint Support Force 909th Hospital of Chinese PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian, 363000,P. R. China
| | - 进 吴
- 中国人民解放军联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科(福建漳州 363000)Department of Orthopaedics, Joint Support Force 909th Hospital of Chinese PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian, 363000,P. R. China
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Daher M, Farraj SA, El Hassan B. Management of Extra-articular Scapular Fractures: A Narrative Review and Proposal of a Treatment Algorithm. Clin Orthop Surg 2023; 15:695-703. [PMID: 37811516 PMCID: PMC10551685 DOI: 10.4055/cios23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 10/10/2023] Open
Abstract
The management of scapular fractures can be either conservative or operative, but it is still unclear how to choose the treatment option. Scapular fractures can be classified anatomically into four types: scapular spine, scapular body, and scapular neck where the treatment is conservative most of the time except for certain indications that are specific to each one, and inferior angle of the scapula where the operative treatment yields the best results but conservative treatment can be contemplated in some cases.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedic Surgery, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Sami Abi Farraj
- Department of Orthopedic Surgery, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Bassem El Hassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Chen X, Deng YD, Qiu XS, Chen YX, Zhang ZT. Analysis of the curative effect and prognostic factors in patients with scapular fracture with surgical indications after conservative treatment: a case series and clinical outcomes. Quant Imaging Med Surg 2023; 13:5130-5140. [PMID: 37581085 PMCID: PMC10423348 DOI: 10.21037/qims-23-278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 08/16/2023]
Abstract
Background The choice of treatment for scapular fractures is a topic worth discussing. The type of scapular fracture is often complex, and more and more scholars prefer surgical treatment to obtain better shoulder joint function. In addition, because of the rich blood supply and muscles of the scapula, some scholars believe that simple suspension can also achieve satisfactory clinical effects. The aim of this study was to investigate the curative effect and prognostic factors of patients with scapular fracture with indications for surgery after receiving conservative treatment. Methods Patients with scapular fracture who did not receive surgical treatment from July 2016 to May 2021 were recruited from the orthopedic trauma database of Nanjing Gulou Hospital, and the data from patients with indications for surgery were screened out for a retrospective analysis. The data were obtained from the database of orthopaedic trauma patients in Nanjing Drum Tower Hospital. The relevant data were recorded during telephone and video follow-up visits. Linear regression was used to analyze the factors associated with disabilities of the arm, shoulder and hand (DASH) score after receiving conservative treatment. Results A total of 21 patients were included in the final statistical analysis. All patients were followed up for 31.0±20.3 (range, 6-63) months, aged 52.9±12.7 (range, 27-71) years. All fractures had clinical healing with a 100% recovery satisfaction rate. Outcome measures of efficacy [both DASH scores and visual analogue scale (VAS) scores], were correlated with whether the fracture involved the superior border of the scapular, were not associated with the following variables: age (P=0.18), Injury Severity Score (ISS) score (P=0.10), the glenopolar angle (GPA) value (P=0.76), superior shoulder suspensory complex (SSSC) injury (P=0.82), and glenoid fracture (P=0.84). The range of motion of the affected shoulder was significantly reduced compared to the healthy shoulder (P<0.01), but the range of forward flexion and elevation was not significantly different from that of the healthy shoulder (P>0.05). Patients with fractures not involving the superior border of the scapula had a much lower range of motion in the affected shoulder than in the healthy shoulder during abduction (P<0.05). Conclusions The range of surgical indications for scapular fractures with scapular fractures involving the lower margin of the scapular can be appropriately narrowed. Some patients with scapular fracture who have surgical indications can regain satisfactory shoulder function after receiving conservative treatment.
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Affiliation(s)
- Xi Chen
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Shoulder and Elbow Surgery, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou, China
| | - Ya-Dian Deng
- Department of Emergency, The First Affiliated Hospital, Henan Traditional Chinese Medicine University, Zhengzhou, China
| | - Xu-Sheng Qiu
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yi-Xin Chen
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zi-Tao Zhang
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Shi H, Zhang K, Hu Y, Wu W, Liu N, Lu H. Novel Claw-shaped Bone Plate in Complex Unstable Scapular Neck and Body Fractures: Comparison with Reconstruction Locking Plate. Orthop Surg 2023; 15:2124-2131. [PMID: 37226558 PMCID: PMC10432470 DOI: 10.1111/os.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE For complex and unstable scapular fractures requiring simultaneous fixation of the glenoid neck, the lateral margin of the body, and/or the scapular diaphysis, reconstruction locking plate is difficult to achieve satisfactory fixation. In order to optimize the fixation effect, the newly designed claw-shaped bone plate was designed for fixing such fractures. We also evaluate the clinical effects and follow-up at an average of 1 year after treatment in scapular internal fixation by using reconstruction locking plate and claw-shaped bone plate in complex unstable scapular body and glenoid neck fracture. METHODS A retrospective study was conducted from 2018 to 2021, thirty-three patients (27 males and six females) who were defined unstable scapular fractures by Ada-Miller. Fifteen patients (52.86 ± 8.26 years) received claw-shaped bone plate and 18 cases (51.61 ± 11.31 years) received reconstruction locking plate with the intermuscular approach. The clinical effect was evaluated based on the operation time, intraoperative blood loss, surgical complications, clinical healing time and Constant-Murley score (CMS). The data analysis by Student t, Mann-Whitney U test and Pearson's chi squared test. RESULTS Compared with reconstruction locking plate, the claw-shaped bone plate showed shorter operation time (102.73 ± 18.43 min vs. 156 ± 37.53, P < 0.0001), higher CMS (94.00 ± 4.07 vs. 89.88 ± 5.42, P = 0.02) and no differences between the two groups regarding intraoperative blood loss (208.00 ± 96.45 mL vs. 269.44 ± 120.21, P = 0.12) and clinical healing times (9.96 ± 1.52 vs. 10.05 ± 1.67, P = 0.87). Follow-up were conducted at first, third, 6 and 12 months after surgery. The operation was successful in all patients with no intraoperative complications. CONCLUSIONS For the treatment of complex and unstable scapular neck body fractures, the application of claw-shaped bone plate demonstrated short operation time, better stability of the fracture block, and higher CMS. In the intraoperative and postoperative follow-up showed better clinical results and rehabilitation effects.
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Affiliation(s)
- Huiming Shi
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Kun Zhang
- Orthopaedics Department of Xi'an Honghui HospitalXi'anChina
| | - Yuanjun Hu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Wei Wu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Ning Liu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Haixia Lu
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
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Lou W, Chen J, Li M, Xu D. A new surgical approach for the treatment of scapular glenoid fractures- Axillary approach: A single center case series. Ann Med Surg (Lond) 2022; 79:104029. [PMID: 35860130 PMCID: PMC9289404 DOI: 10.1016/j.amsu.2022.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to assess the efficacy of the scapular glenoid fractures by a new surgical approach (Axillary approach) through follow-up studies. Method We retrospectively analyzed the prospectively collected data from 11cases of glenoid fractures were treated by open reduction and internal fixation through a Axillary approach approach between July 2019 and October 2020. All patients were required to conform to regular follow up postoperatively. X-ray film and CT scan was applied to all cases. The Constant score system, the UCLA score system and DASH score system were used to evaluate functional results. Results All patients achieved bone union. At the final follow-up, the mean Constant score was 92.5 ± 3.0 (range 85–97) points and the mean UCLA score was 33.5 ± 1.6 (range 31–36) points. According to the UCLA score system, two patients achieved excellent results and one patients had good results. The mean DASH scores were 7.7 ± 3.2 (range 4–12). Compared with the preoperative functional score, it was significantly improved (P < 0.01). Conclusions The axillary approach as a new method for scapular glenoid fractures (especially the fracture of the lower half of the scapular glenoid) has achieved desired results, and it can provide new options for clinical treatment. Level of evidence Level III; Development or Validation of Outcome Instrument© 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved. The axillary approach as a new method for scapular glenoid fractures. Through more than 1 year of case collection, we found that the therapeutic effect is positive. It is a recommended method in clinical treatment.
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