Comparative Study of Trans-Axillary Approach and Delto-Pectoral Approach to the Treatment of Ideberg Types I and II Scapular Glenoid Fractures.

Abstract

Objective: Clinically, simple glenoid fractures are less prevalent, and surgical treatment of anterior glenoid fractures is often based on the classic anterior approach (delto-pectoral approach), while there are few reports on the efficacy of the trans-axillary approach. The objective of this study is to explore the clinical efficacy of both approaches in the treatment of Ideberg Types I and II scapular glenoid fractures.

Methods: The trans-axillary approach is the surgical method of exposing a glenoid fracture along the anterior edge of the latissimus dorsi muscle through an axillary incision. In terms of the Ideberg classification of scapular glenoid fractures, 36 patients with Ideberg Types I and II scapular glenoid fractures were retrospectively analyzed. There were 22 males and 14 females, and 9 cases of traffic injuries, 6 cases of high fall injuries (> 1 m), 18 cases of fall injuries (≤ 1 m), and 3 cases of strain injuries. Meanwhile, there were 29 cases of Type Ia, 2 cases of Type Ib, and 5 cases of Type II. Based on the surgical approach, the patients were divided into the trans-axillary approach group (21 cases) and the delto-pectoral approach group (15 cases). The following data were collected: general information including age, gender, and body mass index; hospitalization time, operation time, bleeding volume; disability of the arm, shoulder, and hand (Quick DASH [QDASH]); and patient satisfaction. Comparisons between the groups were made using the t test for two independent samples.

Results: Operative time was significantly shorter in the trans-axillary approach group than in the delto-pectoral approach group (t = 6.39, p < 0.05). Constant-Murley score was significantly higher in the trans-axillary approach group than in the delto-pectoral approach group (t = 4.96, p < 0.05). QDASH score was lower in the trans-axillary approach group than in the delto-pectoral approach group (t = 2.66, p < 0.05). Patient satisfaction was higher in the trans-axillary approach group than in the delto-pectoral approach group (t = 4.5, p < 0.05). All fractures healed by the final follow-up.

Conclusion: Trans-axillary approach to the treatment of scapular glenoid fractures is less traumatic and less painful, associated with good recovery of shoulder joint function and high patient satisfaction, and more advantageous compared with the delto-pectoral approach.