Arthroscopic Screw Fixation Technique for Transverse Glenoid Fractures
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ABSTRACT:
SUBMITTER: Wafaisade A
PROVIDER: S-EPMC8626685 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The most common procedure to address transverse glenoid fractures that are characterized by intra-articular step-off or gapping is open reduction and internal fixation. Disadvantages of open surgery are delay in regaining full range of motion, increased approach morbidity, neurovascular complications, and the need for capsulotomy, which delays healing and increases the risk of stiffness. An arthroscopically assisted fracture fixation, as described in this article, is characterized by better visualization of the glenoid articular surface and reduction of the intra-articular fragments under direct vision, which diminishes the chances of residual step-off after fixation. Furthermore, arthroscopic fixation provides the advantages of minimal surgical trauma, which speeds up the recovery time, decreased morbidity as there is less blood loss compared with the open technique, lower chance of neurologic injury as there is less dissection around the spinoglenoid or suprascapular notch, less trauma to the joint capsule, and lower chances of stiffness and capsulorrhaphy arthropathy.
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Project description:Operative treatment of scapular fractures with extension into the glenoid can be a challenging clinical scenario. Though traditionally addressed in an open fashion, the morbidity of this approach, complemented by advancements in arthroscopic technique and instrumentation, has led to increasing use of arthroscopic-assisted fixation. We describe our technique, including pearls and pitfalls, for minimally invasive fixation of Ideberg type III glenoid fractures. This approach minimizes morbidity, allows optimal visualization and reduction, and provides good functional results.
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Project description:An os acetabuli (OA) increases the contact area and surface area of the acetabulum and is important to maintain congruity of the hip joint. Thus preservation of this ossicle is important to prevent loss of contact area and ensure containment of the femoral head. We describe an all-arthroscopic approach to the fixation of OA with a compression screw. Initially, the fibrous tissue is debrided between the acetabular rim and the OA, a guidewire is placed through the OA up to the acetabular rim, and a screw is inserted over the wire. Compression of the OA is achieved with bone-to-bone contact. This technique prevents loss of femoral head coverage, reducing the risk of subluxation and subsequent osteoarthritis.
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Project description:A bony Bankart fracture is a common injury pattern in anterior shoulder instability. The fracture fragment size varies and the larger the fragment the more likely recurrent instability will occur. When a large bony Bankart fracture is present, surgical fixation is preferred. Both open and arthroscopic approaches exist with multiple fixation techniques including anterior-to-posterior screw fixation, suture anchor bridge fixation, and suture button fixation. Arthroscopic screw fixation is difficult, as the angle necessary to be parallel to the glenoid surface requires a far medial start point and places the nerve at risk. The use of a variable-pitch, headless compression screw placed from posterior to anterior avoids these risks. We describe an arthroscopic technique for glenoid fixation using a posterior-to-anterior, cannulated, variable-pitch headless compression screw for the treatment of an anterior BBF.
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Project description:Several articles have described arthroscopic fixation of coronal shear fractures of the distal humerus. However, not all of them have used purely arthroscopic techniques. In this Technical Note we describe another technique for intra-articular distal humeral fracture fixation using arthroscopy alone. Standard proximal anteromedial, proximal anterolateral, and posterolateral viewing portals are established with soft spot portal for reduction. During intra-articular examination, the fragment involving the capitellum and the trochlea as 1 piece is detected. Closed manipulative reduction under anesthesia is conducted with distraction, varus force, and gradual elbow extension. After closed reduction, reduction of the fragment more precisely under arthroscopic visualization using probe and elevator is performed. The fragment is temporarily fixed using 2 Kirschner wires from posterior direction. Anatomic reduction is confirmed with an image intensifier. Screw guide pin is inserted posteroanteriorly under image intensification, and a headless compression screw is placed over each wire. We describe a safe, reproducible, and minimal invasive technique for the arthroscopic treatment of coronal shear fractures of the distal humerus.
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Project description:Up to one fifth of glenoid fractures are intra-articular and associated with recurrent anterior dislocation. Surgery is often the indicated treatment, and as with many other articular fractures, it aims for a perfectly congruent and flush reconstruction of the articular surface to avoid the onset of secondary degenerative joint diseases. The purpose of this paper is to describe a reproducible, simple arthroscopic technique that uses suture anchors to fix the glenoid fragment with a strong and stable construct called "kissing anchors." This method provides the advantages of both direct and indirect stabilizing effects. It applies 2 anchors, one inside the fragment and the other inside the fracture bed, to stabilize and fix the fragment, and is adequately associated with labrum refixation, which provides the construct with increased stability. However, a surgeon willing to apply it should already be confident with basic shoulder arthroscopy and should have performed an appropriate amount of arthroscopic shoulder stabilizations.
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Project description:Fractures of the coracoid process are uncommon injuries and are usually the result of high-energy trauma or avulsion-type injuries. Typically coracoid fractures treated with nonoperative management have yielded good results. Operative treatment of coracoid fractures is reserved for a subset of clinical situations, including fracture nonunion. We detail our technique for arthroscopic debridement of a Type II coracoid fracture nonunion, as well as the use of arthroscopic-assisted percutaneous fixation for a Type II coracoid fracture.
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Project description:To date, several open and arthroscopic surgical procedures are available for the treatment of anterior glenoid fractures after anterior shoulder dislocation. Open approaches require extensive soft-tissue dissection and are associated with poorer outcomes. Arthroscopic screw fixation techniques are technically challenging and related to complications as well, for example, risk of brachial plexus injury or hardware impingement. Alternative arthroscopic fixation techniques use suture anchors placed along the fracture rim with sutures passed around the fragment. However, these techniques require an intact capsulolabral complex and cannot be used effectively for large fracture fragments. This article describes a safe interfragmentary, transosseous, all-arthroscopic procedure using a double-cortical button fixation technique. This method can be used to achieve anatomic reduction and stable fixation of intermediate to large anterior glenoid fractures while minimizing the difficulties associated with previously described arthroscopic or open approaches.
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Project description:Os acetabuli is thought to be the result of an unfused ossification center or an acetabular rim fracture in the setting of femoral-sided femoroacetabular impingement syndrome. Historically, patients with symptomatic hips have been treated with resection alone; however, in patients with large bone fragments or with reduced acetabular coverage prior to surgical intervention, iatrogenic dysplasia and structural instability may develop after resection. Therefore, for patients with an acetabular os, labral tearing, and cam-type femoroacetabular impingement, internal fixation of the os acetabuli, femoral osteochondroplasty, and labral repair have been described. We propose a "suture-on-screw" arthroscopic technique to simultaneously address both the labral tear and os acetabuli, thereby reducing the number of suture anchors required for labral fixation, leading to an efficient and cost-effective approach for the treatment of these patients.
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Project description:Surgical fixation of displaced, intra-articular glenoid fractures represents a clinical challenge. These fractures have traditionally been treated through open approaches to the glenohumeral joint; however, the morbidity associated with open surgery may be reduced with arthroscopic techniques. Previously described arthroscopic methods commonly use clamps and/or Kirschner wires to obtain and maintain provisional fixation. We describe our technique for minimally invasive, arthroscopic fixation of glenoid rim fractures using labral repair as an indirect reduction maneuver, followed by final fixation with an extra-articular screw. This method is safe, efficient, and reliable, and it can be used to approach a variety of intra-articular glenoid fractures.
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