"Postage Stamp" Fractures: A Systematic Review of Patient and Suture Anchor Profiles Causing Anterior Glenoid Rim Fractures After Bankart Repair

Taylor Woolnough; Ajay Shah; Andrew J Sheean; Bryson P Lesniak; Ivan Wong; Darren de Sa

doi:10.1016/j.arthro.2019.02.047

"Postage Stamp" Fractures: A Systematic Review of Patient and Suture Anchor Profiles Causing Anterior Glenoid Rim Fractures After Bankart Repair

Arthroscopy. 2019 Aug;35(8):2501-2508.e2. doi: 10.1016/j.arthro.2019.02.047.

Authors

Taylor Woolnough¹, Ajay Shah¹, Andrew J Sheean², Bryson P Lesniak³, Ivan Wong⁴, Darren de Sa⁵

Affiliations

¹ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
² San Antonio Medical Center Orthopedics, San Antonio, Texas, U.S.A.
³ Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
⁴ Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
⁵ Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. Electronic address: darren.desa@medportal.ca.

PMID: 31395192
DOI: 10.1016/j.arthro.2019.02.047

Abstract

Purpose: To systematically review patient and technical risk factors for anterior glenoid rim fractures through suture anchor points (i.e. "postage stamp") after arthroscopic Bankart repair.

Methods: An independent, duplicate search of Embase, Medline, and Web of Science databases, in addition to the past 5-year annual meeting abstracts of several prominent shoulder meetings, was conducted according to R-AMSTAR and Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify English-language studies reporting this complication.

Results: A screen of 2,833 studies yielded 6 for inclusion herein. Data across 43 patients, aged 14 to 61 years (mean 24.4), 5% female, and who were followed for 4 to 108 months postoperatively, were reviewed. Only 1 of 6 studies (n = 2) reported postage stamp fracture in female patients. Median time from initial surgery to fracture ranged from 12 to 24 months. Five of 6 studies (n = 32) reported a median age at initial surgery of 25 years or younger (range 17-35). Four of 6 studies (n = 30) reported fracture mostly after sport involvement. All studies (n = 35) reported initial fixation with a median of 3 anchors or more, 3 of 5 studies (n = 26) reported fracture entirely after conventional knot-tying anchors, and 5 of 6 studies (n = 24) reported more fractures after absorbable suture anchor use. Fractures occurred entirely through anchor holes in 5 of 6 studies (n = 29) and mostly after osteolysis in 3 of 4 studies (n = 19). Management strategies after fracture included revision arthroscopic Bankart repair or open Bristow/Latarjet procedures.

Conclusion: Postage stamp fractures were reported frequently in patients who were male, age 25 years or younger, and participants in sporting activities and in fractures initially stabilized with 3 or more anchors or conventional knot-tying anchors or that experienced osteolysis around anchor sites.

Level of evidence: Level IV, systematic review of level III and IV studies.

Publication types

Systematic Review

MeSH terms

Arthroplasty / adverse effects*
Arthroscopy / methods*
Fractures, Bone / complications
Fractures, Bone / diagnosis
Fractures, Bone / surgery*
Humans
Joint Instability / etiology
Joint Instability / surgery*
Postoperative Period
Risk Factors
Shoulder Injuries
Shoulder Joint / surgery*
Suture Anchors*
Suture Techniques / instrumentation*