Bartonicek J, Tucek M, Klika D, Obruba P
Rozhl Chir. 2016 Fall;95(11):386-393.
Fractures affecting the entire glenoid fossa are termed comminuted or total glenoid fractures. However, there are no detailed studies of total glenoid fractures, and only brief mentions can be found in the literature.
The group comprised 12 patients (mean age, 39 years), who sustained 13 fractures of the glenoid fossa. In all the fractures, all parts of the glenoid fossa were separated from the scapular neck or body. In total 5 patients (6 fractures) were treated non-operatively and 7 patients were operated on. The method of treatment was based on displacement of the fragments, the patient´s general and local conditions. Indication for operative treatment was displacement of articular fragments of more than 3mm. This criterion was met by 10 patients (11 fractures). Owing to the general or local condition, operation was contraindicated in 2 patients with 3 fractures; one patient refused the operation. One patient with a bilateral fracture was lost to follow-up.
According to the site of separation of articular fragments, the fractures were divided into three groups - the separation line passed through the anatomical neck; through the coracoid process or surgical neck of the scapula; or through the scapular body. In 6 of the 7 operated patients, a good or very good result was achieved. In 2 patients with minimal fragment dislocation treated non-operatively, the fractures healed in an anatomical position and full range of motion was achieved. In 2 patients with severe fragment displacement treated non-operatively, the healing resulted in glenoid fossa incongruence and painful and limited range of motion.
Fractures of the entire glenoid fossa are the most severe injuries to scapula. Their diagnosis requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment from the Judet approach.Key words: scapular fractures glenoid fractures classification, operative treatment Judet approach.
累及整个肩胛盂的骨折被称为粉碎性或全肩胛盂骨折。然而，目前尚无关于全肩胛盂骨折的详细研究，文献中仅有简短提及。
该组包括12例患者（平均年龄39岁），共发生13例肩胛盂骨折。所有骨折中，肩胛盂的各个部分均与肩胛颈或肩胛体分离。共有5例患者（6处骨折）接受非手术治疗，7例患者接受手术治疗。治疗方法基于骨折块的移位情况、患者的全身及局部状况。手术治疗的指征为关节面骨折块移位超过3mm。10例患者（11处骨折）符合该标准。由于全身或局部状况，2例患者的3处骨折手术治疗为禁忌；1例患者拒绝手术。1例双侧骨折患者失访。
根据关节面骨折块的分离部位，骨折分为三组——分离线穿过解剖颈；穿过肩胛骨的喙突或外科颈；或穿过肩胛体。7例接受手术治疗的患者中，6例取得了良好或非常好的效果。2例非手术治疗的骨折块移位极小的患者，骨折在解剖位置愈合，且实现了全范围活动。2例非手术治疗的骨折块严重移位的患者，愈合后出现肩胛盂不匹配，活动时疼痛且活动范围受限。
全肩胛盂骨折是肩胛骨最严重的损伤。其诊断需要进行CT检查，包括去除周围骨骼的三维CT重建。移位骨折建议采用Judet入路进行手术治疗。关键词：肩胛骨骨折；肩胛盂骨折；分类；手术治疗；Judet入路
