Unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability

Published:November 16, 2022DOI:



      The purpose of the present study was to investigate the characteristics of unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability.


      Participants were 38 patients, who had complaints of instability on only one side (symptomatic shoulder) and had no complaints despite of a glenoid fracture on the other shoulder (asymptomatic shoulder) from 2011 to 2020. Factors that could influence the onset of symptoms including glenoid rim morphology were retrospectively investigated.


      Among the asymptomatic shoulders, 16 had a single traumatic event and 22 had no history of trauma. The glenoid morphology was normal in 6, erosion in 12 and bony Bankart in 20 on the symptomatic side, whereas the respective shoulders were 0, 16 and 22 on the asymptomatic side. Bone union of bony Bankart was complete in 9, partial in 3 and non-union in 8 on the symptomatic side, whereas the respective shoulders were 18, 3 and 1 on the asymptomatic side. The mean glenoid defect size was 10.4% and 7.8%, and the mean bone fragment size was 5.0% and 4.5%, respectively. The mean medial displacement of bone fragments was 2.6 mm and 1.0 mm, respectively (p < 0.001). A larger glenoid defect (≥10%) was recognized in 19 symptomatic shoulders and 10 asymptomatic shoulders. Among them, erosion was solely recognized in 5 symptomatic shoulders. In shoulders with bony Bankart, all 10 asymptomatic shoulders had a completely or partially united fragment with less than 2 mm displacement. On the other hand, among 14 symptomatic shoulders, united fragment was solely recognized in 8 shoulders, in which medial displacement was less than 2 mm in 3 shoulders.


      Even if a glenoid fracture occurred, symptom such as instability or pain was not always recognized by all patients. Regardless of glenoid defect size, shoulders with a completely or partially united bone fragment and with less than 2 mm displacement were found to be asymptomatic.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sugaya H.
        • Moriishi J.
        • Dohi M.
        • Kon Y.
        • Tsuchiya A.
        Glenoid rim morphology in recurrent anterior glenohumeral instability.
        J Bone Joint Surg Am. 2003 May; 85: 878-884
        • Boileau P.
        • Zumstein M.
        • Balg F.
        • Penington S.
        • Bicknell R.T.
        The unstable painful shoulder (UPS) as a cause of pain from unrecognized anteroinferior instability in the young athlete.
        J Shoulder Elbow Surg. 2011 Jan; 20: 98-106
        • Nakagawa S.
        • Ozaki R.
        • Take Y.
        • Mae T.
        • Hayashida K.
        Bone fragment union and remodeling after arthroscopic bony Bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence.
        Am J Sports Med. 2015 Jun; 43: 1438-1449
        • Nakagawa S.
        • Mae T.
        • Yoneda K.
        • Kinugasa K.
        • Nakamura H.
        Influence of glenoid defect size and bone fragment size on the clinical outcome after arthroscopic Bankart repair in male collision/contact athletes.
        Am J Sports Med. 2017 Jul; 45: 1967-1974
        • Maquieira G.J.
        • Espinosa N.
        • Gerber C.
        • Eid K.
        Non-operative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder.
        J Bone Joint Surg Br. 2007 Oct; 89: 1347-1351
        • Wieser K.
        • Waltenspül M.
        • Ernsbrunner L.
        • Ammann E.
        • Nieuwland A.
        • Eld K.
        • et al.
        Nonoperative treatment of anterior glenoid rim fractures after first-time traumatic anterior shoulder dislocation: a study with 9-years follow-up.
        JBJS Open Access. 2020 Dec 23; 5e20.00133
        • Königshausen M.
        • Pätzholz S.
        • Coulibaly M.
        • Nicolas V.
        • Vandemeulebroecke M.
        • Schidhauer T.A.
        • et al.
        Instability and results after non-operative treatment of large anterior glenoid rim fractures: is there a correlation between fragment size or displacement and recurrence?.
        Arch Orthop Trauma Surg. 2021 Aug 2;
        • Ideberg R.
        • Grevsten S.
        • Larsson S.
        Epidemiology of scapular fractures. Incidence and classification of 338 fractures.
        Acta Othop Scand. 1995; 66: 395-397
        • Boone J.L.
        • Arciero R.A.
        First-time anterior shoulder dislocations: has the standard changed?.
        Br J Sports Med. 2010 Apr; 44: 355-360
        • Galvin J.W.
        • Emat J.J.
        • Waterman B.R.
        • Stadecker M.J.
        • Parada S.A.
        The epidemiology and natural history of anterior shoulder instability.
        Curr Rev Musculoskelet Med. 2017 Dec; 10: 411-424
        • Hovelius L.
        • Eriksson K.
        • Fredin H.
        • Hagberg G.
        • Hussenlus A.
        • Lind B.
        • et al.
        Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment.
        J Bone Joint Surg Am. 1983 Mar; 65: 343-349
        • Kraus N.
        • Gerhardt C.
        • Haas N.
        • Scheibel M.
        Conservative therapy of antero-inferior glenoid fractures.
        Unfallchirurg. 2010 Jun; 113: 469-475
        • Kummel B.M.
        Fractures of the glenoid causing chronic dislocation of the shoulder.
        Clin Orthop Relat Res. 1970 Mar-Apr; 69: 189-191
        • Malhotra A.
        • Freudmann M.S.
        • Hay S.M.
        Management of traumatic anterior shoulder dislocation in the 17- to 25-year age group: a dramatic evolution of practice.
        J Shoulder Elbow Surg. 2012 Apr; 12: 545-553
        • Osti M.
        • Gohm A.
        • Benedetto K.P.
        Results of open reconstruction of anterior glenoid rim fractures following shoulder dislocation.
        Arch Orthop Trauma Surg. 2009 Sep; 129: 1245-1249
        • Raiss P.
        • Baumann F.
        • Akbar M.
        • Rickert M.
        • Loew M.
        Open screw fixation of large anterior glenoid rim fractures: mid- and long-term results in 29 patients.
        Knee Surg Sports Traumatol Arthrosc. 2009 Feb; 17: 195-203
        • Scheibel M.
        • Hug K.
        • Gerhardt C.
        • Krueger D.
        Arthroscopic reduction and fixation of large solitary and multifragmental anterior glenoid rim fractures.
        J Shoulder Elbow Surg. 2016 May; 25: 781-790
        • Van Oostveen D.P.
        • Temmeman O.P.
        • Burger B.J.
        • van Noort A.
        • Robinson M.
        Glenoid fractures: a review of pathology, classification, treatment and results.
        Acta Orthop Belg. 2014 Mar; 80: 88-98
        • Griffith J.F.
        • Antonio G.E.
        • Yung P.S.
        • Wong E.M.C.
        • Yu A.B.
        • Ahuja A.T.
        • et al.
        Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients.
        AJR Am J Roentgenol. 2008 May; 190: 1247-1254