Introduction
Glenoid is a part of scapular bone which
takes part in shoulder gleno-humeral joint. The most common fractures of glenoid are rim and articular fossa fractures. Here, we document a case of glenoid neck fracture which is an uncommon fracture and its treatment with conservative management.

Case Report
26 year old male presented to us in the casualty department after sustaining a bike accident, with direct blow on the left shoulder. His presenting posture was adduction and forward flexion of left arm with 90o flexion at elbow, supported by right hand. On examination, there was swelling and tenderness of left shoulder and lateral third of left collar bone. Bone crepitus was present at clavicle. Because of pain shoulder movements were not tested. There was no deformity of left upper limb, distal pulsations were normal. There was no neurological deficit.

On Radiological examination of left shoulder

AP View revealed glenoid neck fracture with minimal superior displacement, angulation and also lateral third clavicle fracture. Patient was admitted, injectable analgesics were given and shoulder strapping with figure of eight bandage for clavicle fracture was applied. 24 hours Later, Sub Acromial view, True AP and Y view of left shoulder were taken for studying the pattern of glenoid fracture. There was less than 1 cm of displacement and angulation was less than 30o. There was no extension of fracture in the scapula. Patient was treated conservatively with analgesics and shoulder arm immobilizer with clavicle brace for two weeks. Two weeks later x-ray of left shoulder was repeated to know the status of the fracture. Glenoid and clavicle fractures showed no further displacement and angulation.

Patient is doing fine and has achieved painless 45o-50o of abduction, 45o of forward flexion and 30o of extension in three weeks time with physiotherapy. Further range of movement and whether he gets early arthritic changes will be documented by his regular follow up.

Discussion
Glenoid neck fracture is an extremely rare fracture. Only 15 cases of glenoid fractures are recorded.1 They are associated with clavicle fracture. Neer believes that functional result of glenoid neck fracture is not related to the radiographic appearance and open reduction is only necessary if they are associated with clavicle fractures.2 Miller found in 15 patients with displaced glenoid neck fractures, which were treated closed, 40% had weakness of abduction, 50% had subacromial and night pain, and 20% had decreased range of motion.3 Amount of displacement and stability of glenoid neck fracture depends on the presence of an associated fracture of the clavicle or a coraco-clavicular ligament tear.4 Miller recommended open reduction of fracture if glenoid neck fracture is angulated more than 40o or displaced greater than 1 cm.1 Glenoid intra articular fractures are very common and occur due to direct blow on shoulder or fall on an outstretched hand.

Fig. 1 : True AP view of left shoulder ~ Black arrow showing glenoid neck fracture with superior displacement. White arrow showing clavicle lateral third fracture.	Fig. 3 : Y-view of left shoulder ~ showing scapular blade, acromian, clavicle, and humeral head.
Fig. 2 : Sub-Acromial view of left shoulder ~ Circle showing glenoid neck fracture, displaced and angulated.	Fig. 4 : Sub-Acromial view of left shoulder ~ Arrow showing glenoid neck fracture two weeks later.

References

1. Leung KS, Lam TP. Open Reduction and internal fixation of Ipsilateral fractures of the scapular neck and clavicle. J Bone Joint Surg 1993; 75A : 1015-18.
2. Neer CS. II : Fractures, In shoulder Reconstruction, Philadelphia, WB Saunders, 1990.
3. Ada JR, Miller ME. Scapular fractures : Analysis of 113 cases. Clin Orthop 1991; 269 : 174-80.
4. Hardegger FH, Simpson LA, Weber BG. The Emergency Treatment of Scapular Fractures. J Bone Joint Surg 1984; 725-31.
5. Ideberg R. Unusual glenoid fractures : A Report of 92 cases. Acta Orthop Scand 1987; 58 : 191-92.
6. Ideberg R. Fractures of scapula involving the glenoid fossa. In Bateman, JE, and Welsh RP (eds). Surgery of Shoulder, Toronto, BC Decker, 1984; pp 63-66.