[Conservative therapy of antero-inferior glenoid fractures]

The adequate treatment of antero-inferior glenoid rim fractures is a controversial issue. Marginal knowledge exists about the results of non-operative treatment. Therefore, the aim of this study was to evaluate the results of conservative treatment of acute fragment type lesions (type Ib) of the antero-inferior glenoid.A total of 10 patients (5 female and 5 male, mean age 56.5 years) were included in this retrospective study. A complete clinical examination of the shoulders and four functional scores, the Constant Score (CS), Rowe Score (RS), Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) as well as a radiologic evaluation using true a/p and axillary radiographs were performed.After a mean follow-up of 26.4 months no clinical signs of subjective instability or redislocation were found. The median CS reached 80.5 points (range 52-88) versus 84 points (range 73-90) on the healthy contralateral side (p >0.05). The RS, WOSI and SSV achieved 95 points (range 70-100), 86.7% (range 51-99.6%) and 85 % (range 50-100%), respectively. The radiologic evaluation showed a consolidated fragment in all patients. The anterior subchondral sclerosis zone was reformed completely in seven patients. The mean intra-articular step-off was 2 mm (range 0-6 mm). Osteoarthritis was seen in two cases (one grade I and one grade II according to Samilson and Prieto) none of which was symptomatic and the one grade II was present at the time of trauma.The conservative treatment of acute fragment type lesions (type Ib) of the antero-inferior glenoid can lead to excellent and satisfactory clinical results and therefore represents a suitable treatment alternative in the middle aged patient population. Nevertheless, future studies have to explicitly define the exact indications for a conservative versus surgical treatment approach.