A glenoid fracture is a break in the glenoid, the shoulder blade’s socket that forms half of the glenohumeral joint. Isolated glenoid fractures are uncommon; most occur in combination with shoulder dislocations, high-energy trauma, or scapular fractures. The specific fracture pattern drives treatment, ranging from sling immobilization for small, minimally displaced fragments to complex reconstruction for displaced intra-articular fractures.
What Is a Glenoid Fracture?
The glenoid is the shallow socket of the shoulder joint, a concave surface on the lateral edge of the scapula that articulates with the humeral head. The rim of the glenoid is reinforced by the labrum, which deepens the socket and anchors the capsule and ligaments.
Glenoid fractures are classified by location and pattern:
- Anterior rim (bony Bankart) fractures from anterior shoulder dislocation
- Posterior rim fractures from posterior dislocation
- Glenoid neck fractures from direct trauma to the shoulder blade
- Intra-articular fractures that extend across the joint surface, usually from high-energy trauma
- Associated scapular body and neck fractures in polytrauma
The most common glenoid fracture is the bony Bankart lesion, a fragment of the anterior-inferior rim that fractures with an anterior dislocation. Larger rim fractures and displaced intra-articular patterns can affect joint stability and congruity, which drives surgical treatment.
Causes and Risk Factors
- Shoulder dislocation, particularly in older patients with weaker bone and in high-energy mechanisms
- Falls directly onto the shoulder
- Motor vehicle collisions and high-energy trauma, often with associated chest and neck injuries
- Direct blow to the lateral scapula
- Seizures, which produce specific posterior dislocation patterns with associated fractures
Symptoms
- Shoulder pain immediately following injury
- Swelling and bruising over the shoulder and upper chest
- Inability to move the arm without severe pain
- Visible deformity in complex injuries
- Associated symptoms if there are concurrent injuries such as rib fracture or pneumothorax
Diagnosis
Dr. Chudik’s evaluation includes the mechanism of injury and a focused examination including neurovascular assessment. X-rays in multiple views define the fracture and any dislocation. CT is the imaging study of choice for characterizing glenoid fractures because it quantifies displacement, fragment size, and intra-articular involvement with precision. MRI may be added to assess the labrum, capsule, and rotator cuff. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is appropriate for minimally displaced fractures, particularly small rim fragments that do not compromise shoulder stability, and for glenoid neck fractures without significant displacement. It involves a sling, pain control, and progressive motion over four to six weeks.
Surgical treatment is indicated for:
- Displaced rim fractures producing shoulder instability
- Bony Bankart fragments greater than 13 to 15 percent of the glenoid, which Dr. Chudik addresses through his developed Arthroscopic Bony Bankart Repair and Glenoid Reconstruction technique
- Displaced intra-articular fractures affecting joint congruity
- Complex scapular fractures with glenoid involvement requiring open reduction and internal fixation
Recovery and Outcomes
Recovery after non-surgical treatment of minimally displaced fractures typically includes four to six weeks of sling use, progressive motion from two weeks, and return to activity over two to three months. Return to contact sport is typically three to four months pending radiographic union.
Recovery after arthroscopic bony Bankart repair includes four to six weeks of sling protection, progressive motion over two to three months, and strengthening over three to four months. Return to contact sport is typically five to six months.
Outcomes depend on the fracture pattern, the quality of reduction, and the associated soft tissue injuries. Restoring joint congruity and shoulder stability are the two critical goals.
When to See Dr. Chudik
Schedule an evaluation after any shoulder injury that produces significant pain, inability to lift the arm, or a shoulder dislocation, particularly if imaging has identified a glenoid fracture. Call 630-324-0402 or request an appointment online.