A complex glenoid fracture following high-energy trauma: Case report and literature review.

Rationale: Glenoid fractures, representing approximately 10% of scapular fractures, are uncommon but clinically significant due to their frequent association with high-energy trauma. Without timely and adequate management, such injuries may lead to complications including nonunion, osteoarthritis, and chronic instability, especially when fracture patterns are complex or extend into the scapular body. This report highlights the unique diagnostic and therapeutic challenges of managing an Ideberg type Vb glenoid fracture.

Patient Concerns: A 32-year-old male motorcyclist presented with significant swelling and ecchymosis around the left shoulder and axilla, accompanied by complete functional impairment of the shoulder joint. Despite the severity of the trauma, neurological sensitivity was preserved on admission.

Diagnoses: Imaging through radiography and computed tomography with 3-dimensional reconstruction revealed a comminuted glenoid cavity fracture, displacement of the coracoid process, and extension of the fracture line into the scapular body - classified as an Ideberg type Vb fracture.

Interventions: Surgical management was conducted via the Judet approach, involving open reduction and internal fixation using 2 reconstruction plates. These were precontoured on a cadaver scapula model and intraoperatively adapted to the patient's anatomy. Postoperative immobilization with a Velpeau bandage was maintained for 30 days. At 6 months, a secondary procedure - neurotization using sural nerve grafts and direct neuromuscular neurorrhaphy via the Giorgio Brunelli technique - was performed due to persistent motor deficits attributed to infraspinatus nerve injury.

Outcomes: Initial postoperative follow-up showed persistent deficits in external rotation and abduction. Following neurotization, the patient exhibited gradual and substantial functional recovery, with a Constant shoulder score of 86 documented at 2 years post-trauma.

Lessons: This case emphasizes the complexity of Ideberg type Vb glenoid fractures and the necessity for comprehensive diagnostic imaging, individualized surgical planning, and interdisciplinary collaboration. Preoperative plate contouring with cadaveric models and targeted neurological reconstruction were pivotal in achieving a favorable long-term outcome.