Orthonotes
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Types I–V: rim (anterior/posterior), transverse, and complex intra-articular patterns. Large articular fragments or instability need ORIF; small rim fractures stable may be non-op.
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Glenoid fractures are uncommon injuries, accounting for approximately 10% of all scapular fractures. They most commonly result from high-energy trauma — either a direct lateral blow to the shoulder, axial loading through the humerus (a fall onto an outstretched hand), or in association with glenohumeral dislocation. The glenoid provides the socket of the glenohumeral joint, and its disruption affects joint congruency, stability, and long-term shoulder function. The Ideberg classification (1984, later modified by Goss in 1995 to add Type VI) is the standard system for describing glenoid fossa fractures based on the anatomy of the fracture pattern, distinguishing glenoid rim fractures from glenoid fossa fractures and guiding surgical approach selection.
| Ideberg Type | Fracture Description | Mechanism | Clinical Significance | Management |
|---|---|---|---|---|
| Type I — Glenoid rim fracture | A fracture of the GLENOID RIM — the peripheral articular edge; IA = anterior rim fracture (the most common glenoid fracture — the `Bankart fracture` or `bony Bankart`; an avulsion of the anteroinferior glenoid rim by the inferior glenohumeral ligament during anterior shoulder dislocation); IB = posterior rim fracture (less common; from posterior dislocation) | IA: anterior shoulder dislocation — the humeral head avulses the anterior glenoid rim as it dislocates (the `bony Bankart`); IB: posterior dislocation mechanism | Type IA (bony Bankart) is the most clinically important Type I — it affects shoulder stability; the fragment size determines the stability threshold: if the anterior glenoid defect is >25% (some use 20% or `inverted pear` glenoid appearance = >30%) of the total glenoid width → the humeral head is at risk of engagement and re-dislocation (the `engagement threshold`); smaller fragments (<25%) can be managed with soft tissue Bankart repair alone; larger fragments require bony augmentation (Latarjet procedure or anatomic bone block augmentation) | IA: <25% defect with associated soft tissue → arthroscopic Bankart + capsulorrhaphy; ≥25% defect → Latarjet coracoclavicular transfer or Bristol bone block; IB: reverse Bankart repair (posterior capsulolabral reconstruction); large posterior rim fragment → ORIF |
| Type II — Transverse inferior glenoid fossa fracture | A TRANSVERSE fracture across the inferior glenoid fossa; the fracture line runs horizontally through the lower glenoid and exits inferiorly through the scapular neck; the inferior glenoid fragment is displaced inferiorly; the humeral head may sublux inferiorly with the inferior fragment | Axial loading with inferior-directed force or direct inferior blow; the inferior humeral head drives down against the inferior glenoid | The inferior glenoid fragment displacement can compromise joint congruency and inferior glenohumeral stability; the axillary nerve is at risk from the displaced inferior fragment; CT is essential to characterise fragment size and displacement | Non-operative if <5 mm displacement and concentric humeral head position; ORIF via posterior (Judet) approach for >5 mm articular displacement or humeral head subluxation; the posterior approach provides direct visualisation of the inferior glenoid fragment |
| Type III — Superior glenoid ± coracoid fracture | A fracture through the SUPERIOR glenoid fossa; the fracture line exits superiorly through the glenoid neck and typically involves or exits near the coracoid; the superior glenoid fragment may include the coracoid process; may be associated with acromioclavicular joint disruption (`superior shoulder suspensory complex` injuries) | Superior axial loading through the humerus (landing on the hand with the arm at the side); forces are transmitted superiorly and fracture the superior glenoid and coracoid | Superior glenoid fractures with coracoid involvement may be part of the `floating shoulder` complex; associated with acromioclavicular joint injury; the suprascapular nerve passes through the suprascapular notch immediately behind the coracoid base → coracoid fractures at the base can injure the suprascapular nerve → supraspinatus/infraspinatus denervation | Non-operative if undisplaced and concentric humeral head; ORIF if significantly displaced (typically >5 mm) or associated with a floating shoulder; anterior approach for coracoid fixation if required |
| Type IV — Horizontal body fracture | A HORIZONTAL fracture through the glenoid that extends into the BODY of the scapula medially; the fracture line runs from the glenoid fossa through the scapular body; the entire inferior portion of the glenoid and body is separated; this is a more extensive fracture than Type II because it involves the scapular body | High-energy direct trauma or axial loading; the fracture line extends significantly into the scapular body | The extent of scapular body involvement and the displacement of the inferior glenoid determine the need for fixation; significant articular displacement requires ORIF for joint reconstruction | Non-operative for undisplaced or minimally displaced fractures; ORIF via posterior Judet approach for displaced fractures; the Judet approach (posterior interval between infraspinatus and teres minor — the modified Judet, or the interval above and below the spine of the scapula) provides excellent access to the scapular body and posterior glenoid |
| Type V — Combined glenoid + body fracture | A COMBINATION of Type II or III with Type IV; both the glenoid fossa (transverse fracture) AND the scapular body fracture are present simultaneously; the fracture pattern has multiple components involving the glenoid and the scapular body | Very high-energy trauma; the combination creates extensive scapular disruption | The most complex fracture type prior to Type VI; the floating glenoid and associated injuries (floating shoulder, neurovascular) must be assessed; typically requires surgical fixation for the multiple displaced components | ORIF for displaced fractures via Judet approach; the multiple fracture lines require systematic fixation of each component; often requires combined anterior + posterior approaches for Type V injuries |
| Type VI — Comminuted glenoid fossa (Goss addition) | COMMINUTED fracture of the entire glenoid fossa; the articular surface of the glenoid is shattered into multiple fragments; added by Goss in 1995 to the original Ideberg system (which had only Types I–V); this represents the most severe glenoid injury | Very high-energy direct impact or axial loading that shatters the glenoid fossa; associated with glenohumeral dislocation and severe soft tissue injury | The worst prognosis for glenohumeral joint function; anatomical reconstruction of the comminuted glenoid may not be possible; risk of post-traumatic glenohumeral arthritis regardless of management; in young active patients, attempt ORIF; in elderly patients, primary shoulder arthroplasty (reverse shoulder arthroplasty) may be the best salvage option | ORIF attempted in young patients; primary reverse shoulder arthroplasty for elderly with severe comminution; the posterior Judet approach provides best access; post-traumatic arthritis is the common long-term outcome |
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