Fragment-specific management for scapular glenoid fractures

Scapular glenoid fractures are rare, accounting for approximately 0.1% of all fractures. Because of their morphological diversity and complex anatomy, selecting an optimal surgical approach remains challenging. This study aimed to evaluate the outcomes of a "fragment-specific management" strategy, in which the surgical approach was selected according to the fragment location and morphology of scapular glenoid fractures.

A retrospective analysis was conducted on 15 patients who underwent open reduction and internal fixation for scapular glenoid fractures between 2013 and 2024. The surgical indication was defined as an articular step-off or gap ≥ 4 mm on 3D-CT. The deltopectoral, Brodsky, superior, and Judet approaches were selected individually or in combination according to fragment specificity. Radiological outcomes (articular gap and step-off), complications, and functional outcomes including shoulder range of motion and numerical rating scale (NRS) pain scores were evaluated.

The mean age was 52.2 years (range, 31-73), with three female and twelve male patients. The injury mechanisms included falls from standing (n = 3), falls from height (n = 7), bicycle accidents (n = 2), and motorcycle accidents (n = 3). According to the Ideberg classification, there were six type I, two type II, three type III, two type IV, and two type V fractures. The deltopectoral approach was used in nine patients, the Brodsky approach in two, and combined approaches in four (deltopectoral-Brodsky, deltopectoral-superior, deltopectoral-Judet, and triple approach). The mean preoperative step-off and gap were 5.2 mm and 8.5 mm, improving to 0.1 mm and 0.6 mm postoperatively. No infections or nonunions occurred. At the final follow-up, the mean forward flexion, abduction, and external rotation were 144°, 147°, and 46°, respectively, with a mean NRS score of 0.8. All cases achieved bone union and satisfactory function.

Fragment-specific management provided excellent reduction, stable fixation, and favorable functional outcomes without major complications. This approach may be a safe and effective treatment strategy for scapular glenoid fractures.