Glenoid Fractures

Modern Study Review (AI-Generated)

High-Yield Summary

Glenoid fractures are uncommon but clinically significant injuries often associated with shoulder dislocations or high-energy trauma. Accurate diagnosis and classification are essential to guide treatment and optimize shoulder stability and function. Modern management balances non-operative care for minimally displaced fractures with surgical fixation for displaced or unstable patterns to prevent chronic instability and post-traumatic arthritis.

Key Diagnostic Findings

Anatomy

• The glenoid is the shallow, pear-shaped articular surface of the scapula that articulates with the humeral head.
• It comprises the glenoid fossa and the glenoid rim, critical for shoulder stability.
• The inferior glenoid and scapular body are common fracture sites in complex injuries.

Clinical Presentation

• History of trauma, often a shoulder dislocation or direct blow.
• Pain, swelling, and limited shoulder range of motion.
• Mechanical symptoms or instability may be present in displaced fractures.

Imaging

• Plain radiographs: AP, scapular Y, and axillary views to identify fracture pattern and displacement.
• CT scan with 3D reconstruction: Gold standard for detailed assessment of fracture morphology and planning surgery.
• MRI may be used to assess associated soft tissue injuries.

Classification Systems

Note: The Ideberg classification remains widely used, but modern imaging allows more precise subtyping and surgical planning.

Current Gold Standard Treatment

Non-operative

• Indicated for minimally displaced fractures (<5 mm displacement) without instability.
• Immobilization in a sling for 2-4 weeks followed by early passive and active range of motion.
• Close clinical and radiographic follow-up to monitor for displacement or instability.

Operative

• Indications:
• Displacement >5 mm or step-off affecting articular congruity.
• Glenoid rim fractures causing recurrent instability.
• Associated scapular body fractures compromising shoulder mechanics.
• Failed non-operative treatment with persistent pain or instability.
• Surgical options:
• Open reduction and internal fixation (ORIF) via deltopectoral or posterior approaches.
• Arthroscopic-assisted fixation in select cases.
• Fixation techniques include screws, plates, or suture anchors depending on fragment size.

Modern Complications & Outcomes

Complications

• Post-traumatic glenohumeral instability or recurrent dislocation.
• Post-traumatic arthritis due to incongruent joint surface.
• Nonunion or malunion leading to chronic pain and dysfunction.
• Neurovascular injury (rare but possible with scapular body extension).
• Stiffness and loss of range of motion.

Outcomes

• Early surgical fixation of displaced fractures improves joint congruity and reduces arthritis risk.
• Non-operative treatment yields good outcomes in stable, minimally displaced fractures.
• Functional recovery focuses on pain relief, restoration of shoulder stability, and range of motion.
• Long-term prognosis depends on initial displacement, associated injuries, and adequacy of reduction.

Classic Clinical Notes

Glenoid Fractures (Ideberg)

• Type I: Glenoid rim fracture (often associated with shoulder dislocation)
• Type II: Separation of segment of inferior glenoid (oblique or transverse)
• Type III: Associated with AC joint injury
• Type IV: Fracture traverses glenoid and body to exit through medial border of scapula
• Type V: Combination of Type II and IV

Last Updated on January 25, 2026 by orthonet