Abstract
PURPOSE: The management of displaced anterior glenoid rim fractures remains a topic of debate, particularly in elderly patients where surgical risks are heightened. While surgical intervention is often recommended to prevent instability and degenerative arthritis, some studies suggest that nonoperative treatment may yield satisfactory results. This study aims to evaluate whether nonoperative treatment of displaced anterior glenoid rim fractures leads to anterior shoulder instability in elderly patients. METHODS: A retrospective review was conducted on patients over 60 years of age diagnosed with Ideberg type Ia anterior glenoid rim fractures (> 5 mm fragment) who underwent nonoperative treatment. Patients with associated injuries, neurological disorders, or dislocated fractures requiring reduction were excluded. Treatment involved sling immobilization for up to 4 weeks, followed by a structured rehabilitation program. Clinical outcomes were assessed using Constant Score (CS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and range of motion. Radiographic evaluation included fracture healing, displacement, and osteoarthritis progression. Statistical analyses were performed using the Wilcoxon signed-rank test and Fisher exact test. RESULTS: A total of 21 patients (mean age: 69 years, mean follow-up: 82 months) were included. No cases of subsequent instability (dislocation or subluxation) were observed. At final follow-up, 71% of fractures showed complete healing, while 28% exhibited partial healing with a ≤ 5 mm step. Functional outcomes were favorable, with mean CS of 86, ASES of 87, and SSV of 89%. External rotation in abduction was slightly limited compared to the contralateral side (p = 0.0026). Radiographic signs of new-onset osteoarthritis were present in 4 patients, but none reported instability-related symptoms. CONCLUSION: Nonoperative treatment of displaced anterior glenoid rim fractures without dislocation in elderly patients provides satisfactory functional and radiographic outcomes, with no evidence of subsequent instability. This approach effectively avoids surgical risks and complications while preserving shoulder function, supporting its role as a viable treatment strategy in this population.