Instability and results after non-operative treatment of large anterior glenoid rim fractures
Bibliographic record
Abstract
\(\bf Introduction\) There is little data available on non-operative treatment of anterior glenoid rim fractures (GRF). Nothing is known about fracture size and displacement in comparison to clinical outcomes and instability in a mainly middle-aged patient population. The aim of this study was to demonstrate the results of non-operative treatment in anterior glenoid rim fractures with the special focus on potential instability/recurrence. \(\bf Methods\) The inclusion criteria were non-operatively treated anterior GRF of at least \(\geq\) 5 mm width using the age- and gender-matched Constant/Murley score (a.-/g.-CMS) and the Western Ontario Instability Index (WOSI). Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill–Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. and axial radiographs) was classified according to Samilson/Prieto. Proportion of fractured glenoid and medial displacement were correlated with the recurrence rate and the clinical scores. \(\bf Results\) \(\it N\) = 36 patients could be followed-up after a mean of 4.4 years [12–140 month, average age: 58 (\(\pm\) 13, 33–86) years]. The a.-/g.-CMS was 93 (\(\pm\) 11, 61–100) points, and the WOSI was 81% (\(\pm\) 22%, 35–100%) on average. The mean intraarticular displacement was 4 mm (\(\pm\) 3 mm; 0–14 mm). The 2D-circle-method showed a mean glenoid fracture involvement of 21% (\(\pm\) 11, 10–52%). Two cases of frozen shoulders and one case with biceps pathology were associated with the trauma. Within the followed-up patient group re-instability has occurred in \(\it n\) = 2 patients (6%) within the first two weeks after trauma. Osteoarthritis was found in \(\it n\) = 11 cases. There was no correlation between the scores and the fracture size/displacement [(a.-/g.-CMS vs. displacement: \(\it r\) = − 0.08; \(\it p\) = 0.6; vs. size: \(\it r\) = − 0.29; \(\it p\) = 0.2); (WOSI vs. displacement: \(\it r\) = − 0.14; \(\it p\) = 0.4; vs. size: \(\it r\) = − 0.37; \(\it p\) = 0.06)], but very large (\(\geq\) 21%) fractures with displacement \(\geq\) 4 mm showed slightly worse results without significant difference (a.-/g.-CMS \(\it p\) = 0.2; WOSI \(\it p\) = 0.2). The apprehension test was negative in all patients at final follow-up. \(\bf Conclusion\) Non-operative treatment of anterior GRF was associated with overall good results within a mainly middle-aged larger patient group. Re-instability is rare and is not associated with fragment size but can occur in the first weeks after trauma. Size and dislocation of the fracture is not a criterion for the prognosis of potential instability. \(\textbf {Level of evidence}\) Level IV, retrospective case series.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".