Clinical Outcomes Following Glenoid Neck Fracture as Correlated With Quantitative Assessment of Osseous Injury

Extraarticular fractures (fracture not involving the glenoid articular surface) of the
scapula (shoulder blade) have been traditionally managed nonoperatively. The logic for this
course of treatment was based on the healing potential of the extensive muscular envelop of
the scapula, the inherent mobility of the shoulder joint, and the difficulty in objectively
assessing the degree of injury given its irregular osseous architecture.

Scapular fractures specifically involving the glenoid neck have the potential to
significantly change the geometry of glenohumeral joint (shoulder joint) as well as affect
the actions of muscles and nerves that act across it. Although most reports indicate patients
sustaining glenoid neck fractures did well following nonoperative treatment, there was little
use of validated outcome measures. Additionally, the context of severe trauma may have lead
to an underestimation of functional recovery.

Advances in imaging technology combined with the evolution of internal fixation techniques
have resulted in sporadic attempts at fixation of glenoid neck fractures, usually when they
occurred in concert with bony injury to other members of the shoulder girdle, as in the
"floating shoulder". However, in the absence of a universal canon of radiograph measurements,
there are no current recommendations for operative versus non-operative management based on
the characteristics of osseous injury as correlated with probable clinical outcome. Moreover,
the common assertion that nonoperative management of scapular fractures leads to adequate
functional outcome has not been rigorously examined in a prospective fashion, despite this
being the standard of care nationally.

Recent evidence suggests that nonoperative treatment may lead to significant decreases in
strength and forelimb function despite the fact that the standard of care for the vast
majority of these injuries does not involve surgery or reduction. The same may be true of
glenoid neck fractures, as significant shortening or angulation of this metaphyseal isthmus
may have a detrimental effect on the functional geometry of the glenohumeral (shoulder)
joint. If so, surgical management may be indicated to restore a more physiologic geometry to
the joint, and thereby give the best chance of recovery to a pre-injury level of function. It
is our hope that these correlates of measurements and outcome will help codify an a priori
set of radiograph evaluation criteria to help guide decisions for surgical versus
non-operative management of glenoid neck fractures. The purpose of the study is to: 1) define
the degree of forelimb dysfunction brought about by this specific injury and 2) the magnitude
of osseous injury to the glenoid neck that can be tolerated before functional outcome is
unacceptably impeded.

Inclusion Criteria:

- Adults 18-65 and 65+

- Extraarticular scapular fractures Scapular fracture is isolated or in concert with
nondisplaced ipsilateral fractures of the clavicle, coracoid or acromion or has a
clavicle fracture been operatively reduced or fixed?

- Patient is free of preexisting neuromuscular or psychiatric dysfunction

- Patient is free of previous upper extremity injury that would impede objective
functional outcome evaluation

- Patient received a CT scan as part of their initial clinical care

- Patient is English speaking

- Patient is signed the informed consent form

Exclusion Criteria:

- Preexisting upper extremity injury or neuromuscular condition

- Displaced fractures of the acromion, clavicle, or coracoid

- Concomitant injury to the forelimb

- Patients mentally or physically unable to perform the function evaluation

- Patients unwilling or unable to follow up for 1 year

- Patients with poor propensity to follow up; drug, alcohol issues, etc.

- Non English speaking patients

- Patients currently or pending incarceration in prison