. 2017 Jun 26;6(3):e879–e885. doi: 10.1016/j.eats.2017.02.018

Table 2.

Pearls and Pitfalls of Arthroscopic Fixation of Glenoid Fractures

Pearls	Pitfalls
Appropriate planning of portal placement is essential: wrong portal placement complicates the K-wire trajectories, extends surgical time, and increases risk for neurovascular injury. In the beach chair position, one can convert to open surgery easier than the lateral position. Downsizing the length of the screws is essential to avoid injury to the neurovascular structures. Partially threaded cannulated screws achieve better fracture compression than fully threaded. Tightening of the screws sequentially, one at a time, results in better control and alignment of the fracture.	Exact screw length is difficult to judge arthroscopically. Muscular or obese patients may require long cannulas, which makes fragment manipulation challenging. Excessive manipulation of the shoulder during fluoroscopy and after placement of the cannulated screw guidewires may result in bending of the guidewires. Revision surgery usually requires an open approach. Vascular injuries may not be seen immediately. Conversion to open surgery adds to the time required for bleeding control. During the learning curve, vascular surgery backup may be required depending on the arthroscopy skills of the orthopaedic surgeon.

Pearls

Pitfalls

Appropriate planning of portal placement is essential: wrong portal placement complicates the K-wire trajectories, extends surgical time, and increases risk for neurovascular injury.
In the beach chair position, one can convert to open surgery easier than the lateral position.
Downsizing the length of the screws is essential to avoid injury to the neurovascular structures.
Partially threaded cannulated screws achieve better fracture compression than fully threaded.
Tightening of the screws sequentially, one at a time, results in better control and alignment of the fracture.

Exact screw length is difficult to judge arthroscopically.
Muscular or obese patients may require long cannulas, which makes fragment manipulation challenging.
Excessive manipulation of the shoulder during fluoroscopy and after placement of the cannulated screw guidewires may result in bending of the guidewires.
Revision surgery usually requires an open approach.
Vascular injuries may not be seen immediately. Conversion to open surgery adds to the time required for bleeding control.
During the learning curve, vascular surgery backup may be required depending on the arthroscopy skills of the orthopaedic surgeon.