Management of Non-Displaced Glenoid Fracture
Non-displaced glenoid fractures should be managed non-operatively with early mobilization as pain allows, as these injuries consistently demonstrate excellent functional outcomes without surgical intervention.
Initial Diagnostic Approach
Start with standard shoulder trauma radiographs including AP views (internal and external rotation) and an axillary or scapula-Y view 1. CT without IV contrast is essential for comprehensive fracture characterization, as it identifies subtle non-displaced fractures that may be missed on plain films and is the most useful modality for detecting scapular fractures 1. The 3D reconstruction helps determine precise displacement measurements that guide treatment decisions.
Treatment Algorithm Based on Displacement
Non-Displaced or Minimally Displaced (≤3mm)
- Conservative management is the standard of care
- Immobilization in a sling for comfort (typically 2-3 weeks)
- Early range of motion exercises as pain tolerates
- Progressive strengthening after initial healing phase
The evidence strongly supports this approach: fractures with intra-articular displacement ≤3mm have uneventful outcomes with significantly better Constant-Murley scores compared to displaced fractures 2. Multiple studies confirm that undisplaced fractures managed non-operatively achieve average Constant scores of 86 points 3.
Displaced Fractures (≥5mm displacement or gap)
Surgical intervention should be considered when:
- Translational displacement ≥10mm 4
- Angulatory displacement ≥40° in coronal or transverse plane 4
- Intra-articular displacement ≥5mm with fracture gap ≥5mm 2
The rationale: displaced or angulated fragments lead to nonunion, malunion, and post-traumatic osteoarthritis if the fracture gap persists 2. Operative treatment for displaced fractures yields average Constant scores of 87.25, compared to only 58.55 for non-operatively managed displaced fractures 3.
Critical Distinction: Fracture Type Matters
Glenoid fractures fall into two categories with different implications 5:
- Glenoid neck/body extension fractures: High-energy trauma, often polytrauma patients
- Glenoid rim fractures: Lower energy, associated with instability events
For rim fractures specifically, even large fragments (≥21% of glenoid surface) with displacement ≥4mm can be managed non-operatively with good results in middle-aged patients, though re-instability can occur in the first 2 weeks 6.
Common Pitfalls to Avoid
- Don't rely on plain radiographs alone: Scapular fractures are frequently missed on radiographs, especially when non-displaced 1
- Don't ignore associated injuries: These are high-energy injuries with frequent concomitant trauma that may delay or contraindicate surgery 3
- Don't assume size predicts instability: Fragment size and displacement don't correlate with recurrent instability in anterior rim fractures 6
- Monitor early for instability: The 6% re-instability rate occurs within the first 2 weeks after trauma 6
Expected Outcomes
Non-operatively managed non-displaced glenoid fractures achieve:
- Mean Constant-Murley scores: 79-86 points 2, 3
- Mean WOSI scores: 77% 2
- Mean Rowe scores: 93 points 2
- Low re-instability rate (6%) 6
The key determinant of outcome is displacement, not fragment size 2, 6. Fractures with persistent gaps or angulation leading to malunion have poor outcomes including nonunion and post-traumatic osteoarthritis 2.