Open Latarjet for Acute Anterior Dislocation with Severe Anterior Glenoid Rim Fractures Provides Stable but Arthritic Shoulder at Long-term Follow-up

Esteban Andres Lobos Centeno ; Dominique Saragaglia; Vincent Martinel; Johannes Barth

Abstract

Background: Large anterior glenoid rim fractures, known as Ideberg IIa, particularly those with persistent static subluxation despite appropriate immobilization, are best treated by reduction and internal fixation, utilizing either open or combined arthroscopic techniques.Purpose: This study evaluated functional and radiological results of acute shoulder dislocations, associated with a large bone avulsion of the antero-inferior glenoid rim, treated with a modified Latarjet procedure.Materials and Methods: From January 1991 to December 2000, 12 patients were admitted with an acute anterior dislocation associated with an anterior glenoid rim fracture greater than one-third of its glenoid surface. The sample was composed of 7 males and 5 females. Ten of them underwent an Open Reduction and Internal Fixation, using the modified Latarjet procedure. A standard deltopectoral approach was used, followed by coracotomy and reduction of the glenoid fragment, fixed with a 3.5 mm cortical screw. The coracoid graft was then placed in front of the fragment and secured with a malleolar screw, creating a “bone block sandwich”. The subscapularis tendon was reattached to its humeral stump. The Mean age was of 57 years old (range, 25-82). A direct trauma was involved in 67 % of the cases. The patients were assessed according to Constant score and had X-rays evaluation (Samilson criteria).Results: 9 of the 10 operated patients could be followed up. The Mean follow-up was 6 years (range, 3-11 years). None had shoulder instability. The mean Constant score was 82.2/100 (with a difference of 16.1 points compared to the other side). The mean weighted Constant score was 88.6/100. Two patients showed severe osteoarthritis images on the X-ray findings (stage 4). We also observed three stages 2, one stage 1, and two normal X-rays. In three cases, the coracoid bone block was slightly lateralized.Conclusion: The modified Latarjet procedure provided stable shoulder outcomes in patients with large glenoid rim fractures (>20%). However, glenohumeral osteoarthritis was observed in 63% of cases at mid- to long-term follow-up, regardless of age.What this study adds: This study provides surgical details on performing an open reduction and internal fixation for a large anterior glenoid rim fracture (Ideberg IIa) with the combined coracotomy to ease the approach, subsequently associated with the Latarjet technique to increase stability. Stability is achieved in all cases; however, concerns about osteoarthritis in long-term follow-up are noted.Potential impacts on research, practice, or policy: The quality of reduction and stability should not be the sole focus of our research; the long-term evaluation of osteoarthritis must be considered, regardless of whether nonoperative or surgical techniques are chosen for severe anterior glenoid rim fractures. Further research is necessary to understand the cause of this osteoarthritis, whether it is due to the trauma or the surgical technique.Study Design: Retrospective studyLevel of Evidence: Level 4Keywords: Bony Bankart; Anterior glenoid rim fracture; Anterior shoulder instability; Latarjet; Post-instability osteoarthritis; Ideberg IIa.https://doi.org/10.70885/hmsj.2025.05.003

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