Preoperative arthroscopic assessment of fractures about the shoulder

Soft tissue lesions in fractures about the shoulder are not completely defined by conventional imaging procedures. The purpose of the present study was to arthroscopically determine the soft-tissue pathology of the labrum, capsuloligamentous, and rotator cuff structures associated with fractures of the proximal humerus and/or scapula and to correlate them to the fracture type. In a series of 80 fractures (52 proximal humeral fractures, 20 fracture-dislocations, 8 glenoid or scapular fractures) arthroscopy was performed through a posterior approach under general anesthesia. Arthroscopy revealed significant numbers of labral, capsuloligamentous, and rotator cuff lesions, as well as cartilage damage not identified by clinical examination or preoperative imaging. Fracture dislocations (Neer type VI) and more benign fractures of the two-part variety are frequently associated with labral lesions (in 56% and 31%, respectively). This data suggest that it is important not to underestimate soft-tissue pathology in fractures that seem radiologically relatively harmless. Arthroscopic assessment in shoulder fractures is shown to be a useful tool in completely understanding the extent of the injury.