glenoid fracture radiology

Key points: • The prevalence of condylar fracture was 64.8 % in patients with mandibular fractures. Introduction. It is often caused by repetitive movements such as overhead throwing, causing general pain and weakness. Scroll through images. Plain radiographs are always indicated, and most glenoid fractures will require advanced imaging in the form of CT scan. Patients with scapular fractures present with the upper extremity adducted against the body and protected from movement. The scapula itself is mobile (its orientation shifts on your back with movement), and normal scapular motion is important for normal shoulder function. In this article, we discuss the normal development of the three major components of the shoulder—the glenoid, proximal humerus, and acromioclavicular joint ( ACJ )—as noted on radiographs and MR images, with emphasis on distinguishing normal anatomy from imaging pitfalls related to skeletal maturation. Fracture of the anteroinferior glenoid fossa. Glenoid Dysplasia - 15 images - chronic shoulder instability secondary to glenoid, shoulder arthritis rotator cuff tears causes of, glenoid dysplasia radiology case, posterior glenohumeral instability radsource, . standard for diagnosis and evaluation of the fracture and its associated injuries axial scan with coronal, sagittal and 3D reconstructions are used in the assessment of scapular injuries Classification intra-articular glenoid fracture type I : avulsion of anterior glenoid margin Glenoid fractures are uncommon fractures of the shoulder but are important to recognize as they are often associated with concomitant injuries to chest, head, brachial plexus and humerus 2. Scapular notching is a unique complication of RTSA. Stellate glenoid fractures usually follow a direct blow to the lateral shoulder Types ? Radiological studies are crucial not only for detecting glenoid bone defects but also for measuring the amount of bone loss. Glenoid rim fractures most often result from force transmitted along the humerus after a fall onto a flexed elbow. Return to Glenoid Fracture . Glenoid rim fractures were present in 49 (21%) of 233 dislocated shoulders. Hill-Sachs fracture: subchondral fracture along the posterolateral humeral head. An impaction fracture is also present at the posterior glenoid rim (blue arrow). Glenohumeral dislocations usually result from direct injury during contact sports. Intraarticular fractures of the glenoid fossa are only 1% of scapular fractures and are associated with high impact trauma. [5] Conclusion: Glenoid fossa fractures with displacement of ≥ 5 mm should be treated surgically if the patient's condition allows. Reverse osseous Bankart fracture is a fracture of the posteroinferior rim of the glenoid that may occur after posterior glenohumeral dislocation (Figs. Bankart fracture: anteroinferior glenoid fracture. The Shoulder: Acquired Disorders. 1,699 views March 20, 2018 16 ; 04:30. Login to view comments. The glenoid or glenoid cavity or fossa is the shallow depression of the scapula found on the lateral angle. It is defined as a detachment of the anteroinferior labrum associated with a glenoid rim fracture. Spectrum of Findings. NYU Langone Orthopedics . Anterior Dislocation of the Shoulder. Conventional computed . Michael J. Gardner, Bryan T. Kelly, and Dean G. Lorich. 5, 14, 15 In children, these injuries are most common in the second decade [ 2 ]. Conclusion: Glenoid bone loss is common in anterior shoulder dislocation. What causes it? Unlike their extra-articular counterparts, intra-articular fractures of the glenoid are more complex. Glenoid rim fractures are most commonly seen in recurrent anterior shoulder dislocations resulting in the avulsion of the capsulo-labral-ligament complex. A special glenoid fracture is termed the Bankart fracture. Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill-Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. This is an isolated shoulder injury, and he has no neurologic deficits on physical exam. Publication types Clinical Trial MeSH terms Adolescent Adult Aged Aged, 80 and over Fractures in Musculoskeletal Radiology . Significantly displaced glenoid neck and glenoid fossa fractures that require operative intervention are exceedingly rare and together represent approximately 1 in every 3,000 fractures (5,6). Abstract. Impression. Glenoid Secondary Ossification Centers The normal side-to-side glenoid width variation was small (0.46 +/- 0.81 mm). April 7, 2018. Intraarticular fractures of the glenoid fossa are only 1% of scapular fractures and are associated with high impact trauma. NYU Langone Orthopedics . The lesion can be evaluated within 14-15 mm from the top of humeral head, which should normally be circular. These labral tears make the shoulder unstable and susceptible to repeated. The humeral head has been relocated following an anterior dislocation. Introduction: A typical feature of inferior glenoid fractures is a distal fragment separated from the glenoid fossa. In 1984, Ideberg developed a classification that was based on plain radiology films and consisted of 6 fracture types. Fractures of glenoid of scapula - Ideberg classification | Classifications, online calculators, and tables in radiology Ideberg classification of glenoid fractures has five basic types. The glenoid is the socket part of the ball-and-socket shoulder joint . Bankart fracture This is a post-reduction view. This is known as a 'Bankart' lesion and is not visible on X-rays. Minimally displaced fracture through the tip of the coracoid process. These fractures are typically transverse and occur along the direction of the impact of force. FEATURING Nina Maziak. Collections containing this case: All cases. Hill-Sachs •Hill-Sachs deformity found in 80% of initial anterior shoulder dislocations •Best seen on AP Internal Rotation radiograph •Redislocation based on articular involvement •Engaging Hill-Sachs occurs when lesion catches on A fracture of the anterior glenoid following shoulder dislocation is known as a 'bony Bankhart' lesion. On the coronal image a large Hill-Sachs defect is seen. An award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, hand-out notes, interactive material, most commons lists and pictorial differential diagnoses . By Neil Mulchandani FEATURING Brian Neri , Neil Mulchandani. Biographical Sketch: Thomas Callaway, FRCS (1822-1869) Surgical and Functional Outcomes After Operative Management of Complex and Displaced Intra-Articular Glenoid Fractures. Failure to recognize and correctly address attrition of the fragment and increased instability recurrence rate. Scapula fracture also known as broken shoulder blade represent less than 1% of all broken bones and many of them can be treated without surgery. 1Both authors: Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201. It is based on evaluation of 338 glenoid fractures and was published in 1995. The compression fracture results when the soft bone of the posterossuperior aspect of humeral head impacts against the harder sharper edge of the . Methods. Glenoid Fracture - Arthroscopic Reduction and Internal Fixation. Scapula is a triangular-shaped bone that is protected by a complex system of surrounding muscles (see Figure 1). The shoulder girdle (Figures 4.1-4.3) is made up of three bones—the scapula, clavicle, and proximal humerus—and three joints—the glenohumeral (GHJ), acromioclavicular (ACJ) and sternoclavicular (SCJ) joints.The highly mobile GHJ is formed by the articular surfaces of the humeral head and the glenoid fossa. (OBQ06.159) A 35-year-old male is involved in a motor vehicle accident and suffers the fracture shown in Figure A. Fracture of posterior glenoid rim; Notice the very large fracture of the glenoid rim with displacement. MSK Plain Films. In rim fractures with displacement <5mm, short duration immobilization with radiographic and clinical follow up is recommended. 17.16). 3A and 3B). Glenoid fractures: Ideberg Classification Ideberg R et al, Acta Orthop Scand, 66:395-397,1995. FEATURING Kurtis Carlock , Dalibel Bravo , Sanjit Konda , Austin Ramme , Kenneth A Egol. There is often injury to the glenoid cartilage as a result of shoulder dislocation. Many authors have attempted to classify the glenoid fossa fractures. The glenoid fossa (or glenoid cavity) is a pear-shaped articular surface of the lateral scapula that is covered with articular cartilage, except in its central "bare area." The shallow glenoid fossa accommodates a broad range of motion by the humeral head. Accurate imaging evaluation of glenoid bone loss is necessary to make appropriate preoperative treatment decisions. How the term Bankart lesion became embedded in the radiology literature is unclear, as Bankart emphatically denied the presence of a glenoid rim fracture in any of his cases. Markus Scheibel Arthroscopic reduction and fixation of large anteroinferior glenoid rim fractures. On the coronal-oblique and sagittal reconstruction the displaced fragment of the glenoid rim is seen in the 3-6 o'clock position. glenoid cartilage mri: Glenoid cartilage damage can be seen with anterior and posterior shoulder dislocations on MRI and are part of the so called GLAD lesions. Hill-Sachs lesion best seen on AP view. This video demonstrates an arthroscopic technique for fixation of a posterior glenoid fracture. Glenoid Fracture - Arthroscopic Reduction and Internal Fixation. However, there are no detailed studies of inferior glenoid fractures, and only brief mentions can be found in the literature in this respect. A Glenoid labrum tear is a tear of a fibrous ring of tissue in the shoulder joint. Scapular fractures account for 1% of all fractures 13 and, according to the literature, the glenoid is involved in up to 20% of all scapular fractures. Late complications include humeral and glenoid fractures, metaglene loosening, and scapular notching [65-67]. A Bankart lesion is an injury of the anterior glenoid labrum due to anterior shoulder dislocation. 3 Treatment of Glenoid Fractures and Injuries to the Superior Shoulder Suspensory Complex. Radiological studies are crucial not only for detecting glenoid bone defects but also for measuring the amo … 4 Comments. Two general categories of glenoid fractures exist and differ in mechanism of injury, fracture morphology, and treatment. Address . Glenoid fractures are rare and relatively little is known about their mechanism, fracture pattern and optimal treatment strategies. Glenoid fractures are rare injuries and most can be managed non-operatively. In bony Bankart lesion a bone fracture fragment at the anterior-inferior part of the glenoid is present (Fig. The scapula serves as an attachment site for 17 muscles, which facilitate movement and form a functional soft-tissue envelope for the shoulder girdle [ 6 ]. By Paul J. Favorito, MD 16 Videos. A Modified Judet Approach to the Scapula. Its important to first recognize the normal appearance of glenoid cartilage and its relationship to the labrum, which will help to understand where to look for cartilage damage in a . Glenoid fractures can cause significant morbidity in individuals who are unfortunate enough to sustain one. The first category is glenoid fractures with extension into the scapular neck and body. Many hospitals have their own protocol for shoulder imaging. Glenoid bone loss is measured intraoperatively by the bare spot method, which relies on an anatomic cartilage defect called the bare spot that is assumed to represent the center of the glenoid . Parasagittal, paracoronary and axial reconstructions were examined according to the classifications of Ideberg, Euler and the AO by 3 investigators (orthopedic surgeon, radiologist, student of medicine) at three individual time settings. Glenoid fractures either involve or spare the articular surface. Fractures in Musculoskeletal Radiology. However, there are no detailed studies of inferior glenoid fractures, and only brief mentions can be found in the literature in this respect. Radiology department of the Rijnland hospital, Leiderdorp and the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Shoulder - Anterior dislocation/glenoid fracture - AP. Isolated fractures of the lesser tuberosity should raise suspicion of an associated posterior dislocation Posterior Dislocation of the Shoulder. It's part of the scapula (shoulder blade), which is a thin, broad bone that sits behind the rib cage. Biomechanically this complication is hypothesized to result from mechanical impingement of the superomedial aspect of the humeral component against the inferior scapular neck during . Intra-Articular Glenoid Fracture ORIF via Modified Judet Approach. McGovern Medical School Glenoid fractures are only one third of these injuries (1-4). Most of them are minimally displaced and amenable to nonoperative treatment. It is based on evaluation of 338 glenoid fractures and was published in 1995. Glenohumeral Arthritis. Return to Glenoid Fracture. It is probably . Direct force may cause fractures in all regions of the scapula, while indirect force via impaction of the humeral head into the glenoid fossa can cause both glenoid and scapular neck fractures. A fragment of bone is visible at the anterior-inferior edge of the glenoid. Injuries to the shoulder girdle can range from clinically insignificant avulsion fractures or partial ligament disruptions, to markedly displaced or comminuted fractures that may predispose to long-term shoulder dysfunction. classified glenoid fractures into six types based on plain radiology films: type I glenoid fracture is glenoid fracture without scapular involvement (anterior or posterior rim bony . Image on left demonstrates a "trough fracture" or "reverse Hill-Sachs fracture"of the antero-medial aspect of the humeral head (red arrow) as well as widening of the glenohumeral joint space (black arrow). Introduction: A typical feature of inferior glenoid fractures is a distal fragment separated from the glenoid fossa. In most cases, the inferior glenoid fractures are associated with a fracture of the scapular body. 2,546 views April 7, 2018 24 ; 07:12. However, significant displacement of fractures of the glenoid neck and cavity is an indication for open reduction and internal fixation to achieve optimal upper extremity function. There is a displaced glenoid fracture fragment (arrowhead) from the posterior articular margin of the glenoid Initial evaluation of shoulder arthritis is frequently performed with radiography. An osseous Bankart lesion is commonly seen in patients with an anterior shoulder dislocation. Reverse Hill-Sachs fracture is an impaction fracture of the anteromedial humeral head after posterior humeral dislocation. Many authors have attempted to classify the glenoid fossa fractures. The primary reason to make a shoulder x-ray is to confirm or exclude the presence of a fracture. [B] Lateral view depicts anterior shoulder dislocation. The two bony structures that are commonly injured when the humeral head dislocates are the anteroinferior rim of the glenoid and the posterosuperior aspect of the humeral … • The study suggests a focus on incidental findings such as glenoid fossa fractures. and axial radiographs) was classified according to Samilson/Prieto. •Bony Bankart: anteroinferior fracture of the glenoid. Case Details. Additionally, the image can provide information on the position of the shoulder joint, any bone abnormalities (including bone tumors) and soft tissue disorders (think of calcifications in the rotator cuff muscles). Glenoid fractures are usually the result of blunt trauma to the upper extremity. B, "En face" view of the 3D MRI glenoid model obtained with a range of 1.00 to 1.01 volume intensity shows no clinically significant glenoid bone loss and C, shows a Hill-Sachs lesion (dashed line) at the 3D MRI humeral head model obtained with a range of 2.99 to 3.00 of volume intensity. Here we explain the symptoms, causes, and treatment of a Glenoid labrum tear. Fracture Classification | Radiology Key Fracture Classification Score is a total of 3 components. An osseous Bankart lesion is commonly seen in patients with an anterior shoulder dislocation. (2c) Trough-like defects within both the . Pathophysiology. The number of dislocations correlated moderately with the severity of glenoid bone loss (r = 0.56). Gross anatomy Attachments glenoid labrum : the cavity has a fibrocartilaginous structure on its margin called the glenoid labrum which is continuous superiorly with the tendon of the long head of biceps brachii September 25, 2018. Extra-articular glenoid fractures are classified according to the presence or absence of concomitant acromioclavicular separation or clavicular fracture. The glenoid fossa forms the articular surface of the scapula and connects to the scapular body via the neck of the scapula. Glenoid Labrum Tear. In 1984, Ideberg developed a classification that was based on plain radiology films and consisted of 6 fracture types. Scapular neck fractures most frequently result from an anterior or posterior force applied to the shoulder. Occasionally there is visible injury to the bony glenoid - often called a 'bony Bankart' lesion. The Hill-Sachs lesion is an impression fracture of the humeral head due to impaction of the posterolateral aspect of the anteriorly dislocated humeral head with the anterior rim of the glenoid. The glenoid fossa can be fractured when a high-velocity blunt force causes the humeral head to impact the glenoid cavity. Less commonly, glenoid bone loss can result from a displaced fracture of the anterior glenoid rim (10,11). The Ideberg classification system is the most common system used to describe glenoid fossa and rim fractures 1. "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation. Subtle fractures can be difficult to detect on conventional radiographs; CT may be required for full diagnosis. 0 Comments. Ideberg et al. 1,690 views March 20, 2018 16 ; 04:30. Fractures of the scapula: a retrospective study of 40 fractured scapulae. Glenoid Fracture - Arthroscopic Reduction and Internal Fixation. April 28, 2018. Pathophysiology. Posterior glenoid rim fracture and Hill-Sachs lesion. The size of the fracture fragment defines the grade of instability; fracture fragments involving 1/3th or more of the AP diameter of the glenoid are at risk for development of habitual dislocation and need Bankart repair surgery . Low signal intensity blood clot (arrowhead) is present within the subscapularis recess. Fractures of the acromion and the lateral scapular spine. Glenoid Fracture Teaching Points Sumer S Radiology Blog, Feeds.canoncitydailyrecord.com is an open platform for users to share . Usage This consists of fracture of the inferior lip of the glenoid during anterior shoulder dislocation. An important thing to look for when a post-reduction radiograph of the shoulder has been performed on someone who presented with a glenohumeral dislocation is an associated fracture. [A] Radiographic AP view shows humeral head normally aligned with the glenoid. MR Imaging Features of the Normal Labrum and Normal Labral Variants 2,529 views April 7, 2018 24 ; 07:12. The symptoms of a glenoid fracture may include shoulder pain, swelling, a deformity at the site of the fracture and inability to move the arm. The greater the glenoid bone loss, the more likely the humeral head is to dislocate, resulting in even more glenoid bone loss (1,2). Diagnosis of Glenoid Fractures Your doctor will perform a thorough physical examination and order X-rays or a CT scan to determine the extent of the fracture and displacement of the joint. Arthroscopic Posterior Glenoid Fracture Fixation. Arthroscopic reduction and internal fixation of an anterior glenoid fracture. MATERIALS AND METHODS: Eight patients (seven male patients, one female patient; age range, 15-42 years; mean age, 27 years) with an OCD in the glenoid fossa were identified. FEATURING Nina Maziak. « Previous. 3 Superior glenoid fracture involving the base of coracoid process 4 Horizontal fracture through the neck and body, inferior to the spine 5 Combination of types 2 and 4. Case Discussion Glenoid fractures are uncommon, accounting for ~10% of scapular fractures References 9 public playlist include this case Markus Scheibel Arthroscopic reduction and fixation of large anteroinferior glenoid rim fractures. Scapula fractures can result from high-energy, blunt trauma injuries, such as those . 4,766 views. The avulsions and rim fractures are strongly associated with . Summary. In most cases, the inferior glenoid fractures are associated with a fracture of the scapular body. This fracture is most often seen on an X-ray taken following reduction of a glenohumeral joint . Glenohumeral arthritis is degenerative joint disease of the shoulder characterized by damage to the articular surfaces of the humeral head and/or glenoid. Anterior shoulder dislocation. Radiology 2009;250(2):498-505. In total CT images of 84 patients with glenoid fossa fractures from 2005 to 2018 were included. Figure 6-1. Fractures in Musculoskeletal Radiology. Anatomy. While anterior rim and some superior fossa fractures are approached anteriorly . Multiple acronyms and eponyms are used to describe labral, glenohumeral ligament, and associated shoulder injuries. Hill-Sachs defect (50%) is a depression fracture of posterolateral surface of humeral head from impaction of the head against glenoid rim in subglenoid type. Diagnosis is made radiographically with true AP shoulder ("Grashey") and axillary lateral radiographs. Based on 100 glenoid fractures reviewed over a 10-year period, and its merit lies largely in the epidemiologic con- text in which it was written. Degenerative or post-traumatic osteoarthritis in the shoulder, as with other joints, is frequently associated with osteophyte formation, subarticular . Glenoid fractures are rare, and relatively little is known about their mechanism, fracture pattern and optimal treatment strategies. Glenohumeral dislocation most common shoulder dislocation (85%) Glenohumeral joint dislocations make up >50% of all dislocations in the body. Fractures in Musculoskeletal Radiology. CT scan of the scapula shows the glenoid to be translated medially 3mm, and anglulated 20 degrees from its anatomic axis. (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). Displacement and angulation can lead to nonunion and a poor outcome if the degree of displacement results in a persistent fracture gap in the glenoid fossa or if the angulation of fragments leads to malunion. "bony" vs "soft" (fracture of anterior inferior glenoid vs injury to labrum and glenohumeral capsule/ligament) Easily missed on radiograph so CT is recommended whenever glenoid rim fracture is suspected. Author: Takashi. Fractures involving the glenoid comprise up to 29% of all scapular fractures and occur most commonly in young males ().There is a four times higher incidence in males and the average age at time of injury is 35 years (2,3).A spectrum of injury patterns exists for glenoid . He stated that he had never seen a recurrent dislocation associated with a glenoid fracture and went on to say that if such an association existed, it must be rare. CT arthrography has a higher sensitivity for the diagnosis of glenoid rim fractures and is also used to assess glenoid bone stock in patients with recurrent dislocations ( 41, 43 ), although MR imaging can be used for this indication ( 44, 45 ). A Bankart lesion (15a) is a tear of the anterioinferior glenoid labrum with an associated tear of the anterior scapular periosteum, with or without associated fracture of the anterior inferior glenoid rim. The glenoid cavity is deepened by a fibrocartilaginous ring—the . Click here to Login. . 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