ORIF - Suture anchors

In fractures of the glenoid rim where the glenoid fragments are too small to fix with screws, the glenoid labrum and capsule needs to be reduced and fixed to obtain a stable shoulder. This can be done with the use of suture anchors.

This procedure may be performed arthroscopically or open.

There are number of different suture anchors on the market which vary in size and design. In this illustration we are using the simple cork screw anchor which is inserted arthroscopically.

This procedure may be performed with the patient in either a prone position or lateral decubitus position.

Posterior fragments are reduced and fixed through a posterior arthroscopic instrument portal with the camera inserted anteriorly.

If the surgeon is not familiar with an arthroscopic approach, the posterior approach may be used.

The suture anchor is inserted through the fracture line into bone. The anchors need to be placed sufficiently deep so that the metal part does not protrude above the fracture.

In repairing the labrum, the anchor is placed as close as possible to the articular margin. Once the anchor is securely seated in bone, the handle is removed.

An appropriately angled suture passer is used to shuttle one suture through the labrum.

The sutures are then tied and as the knot is tightened, the fracture is reduced.

The procedure is repeated for any other fragments not suitable for screw fixation.

At the end of any procedure, use the image intensifier to check the placement of fixation devices and the reduction of the joint.

The aftercare can be divided into 4 phases:

1. Inflammatory phase (week 1–3)
2. Early repair phase (week 4–6)
3. Late repair and early tissue remodeling phase (week 7–12)
4. Remodeling and reintegration phase (week 13 onwards)

Full details on each phase can be found here.