A novel concealed posterior axillary approach for scapula glenoid fractures - a multicenter clinical study

Glenoid fractures of the scapula can be treated via anterior deltopectoral, Judet, modified Judet, or posterior minimally invasive approaches; however, these may result in soft tissue injury, hematoma formation, nerve damage, or inadequate internal fixation stability. While arthroscopy minimizes soft tissue dissection, it may pose challenges in visualizing inferior glenoid fragments. To address these potential complications, we designed a new posterior axillary approach, the Tian Yun-Wu Dankai approach (T-W approach), in the treatment of certain glenoid fractures of scapula. We retrospectively reviewed 101 patients (Iderberg Ia, 71; II, 24; IV, 1; and V, 5) treated for glenoid fractures of the scapula using the T-W approach across six medical centers. All patients were followed-up for at least 12 months (range, 12-36 months). Postoperative radiographs and computed tomography scans indicated satisfactory fracture reduction and rigid fixation with plates and screws. The mean incision length, blood loss, and operation time were 10.8 ± 1.3 cm, 104.0 ± 32.7 mL, and 98.0 ± 32.0 min, respectively. At the last follow-up, the mean DASH and Constant scores were 14.0 ± 5.1 and 88.6 ± 3.7, respectively. The mean range of motion of forward flection, abduction, and external rotation was 160.0 ± 19.0°, 156.0 ± 20.0°, and 64.0 ± 8.5°, respectively. Two patients experienced delayed incision healing that resolved with dressing changes. Mild heterotopic ossification was observed in two patients; however, it did not affect shoulder function. Postoperative traumatic shoulder arthritis was observed in one patient. Three patients experienced numbness in the surgical area posterior to the incision site. The T-W approach to treat scapular glenoid fractures (all Ideberg Ia and II, parts IV and V) can fill the gap in the non-inferior approach for the shoulder joint. This approach offers several advantages, including minimal tissue damage, short operative time, effective reduction, rigid fixation, and high functional scores with aesthetic benefits.