Clinical Communication 341

Outcome of Supraglenoid Tubercle Fractures

in 12 Dogs
Elvin R. Kulendra1 Andrew J. C. Beer2 George C. A. Hockley3 Derniese Goh4 Pilar Lafuente5
Karen L. Perry6

1 North Downs Specialist Referrals, Bletchingley, United Kingdom Address for correspondence Elvin R. Kulendra, BVetMed, MVetMed,
2 Charter Veterinary Hospital, Roundswell, Barnstaple, Devon, CertVDI, PgCert(VetEd), DipECVS, FHEA, MRCVS, North Downs
United Kingdom Specialist Referrals, 3 & 4 The Brewerstreet Dairy Business Park,
3 Framlingham Vets, Framlingham, Suffolk, United Kingdom Brewer Street, Bletchingley, RH1 4QP, United Kingdom
4 Peninsula Vet Care Emergency and Referral Hospital, Mornington, (e-mail: ekulendra@ndsr.co.uk).
Victoria, Australia
5 Clinical Sciences and Services Department, The Royal Veterinary
College, Hatfield, Herts, United Kingdom
6 Michigan State University, Veterinary Medical Center, East Lansing,
Michigan, United States

Vet Comp Orthop Traumatol 2019;32:341–350.

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Abstract Objective The aim of this study was to report the outcome and complications of
surgical stabilization following fracture of the supraglenoid tubercle in dogs.
Materials and Methods Data from three referral centres (Queen Mother Hospital for
Animals, Michigan State University and Veterinary Referral Hospital Hallam) were
reviewed retrospectively for cases of supraglenoid tubercle fracture (n ¼ 12).
Results Overall success rate was 9/12. Major complication rate was 2/12 and minor
complication rate was 9/12. All fractures that had major complications were comminuted.
Methods of stabilization included pin and tension band wire (n ¼ 5), lag screw (n ¼ 2),
Keywords plate fixation (n ¼ 2), fragment removal (n ¼ 2) and conservative management (n ¼ 1).
► fracture Clinical Significance Good outcomes can be achieved following fractures of the
► scapula supraglenoid tubercle, although cases with comminution have a higher complication
► supraglenoid tubercle rate. Further research into the optimal method of fixation and postoperative manage-
► dog ment is required.

Introduction supraglenoid tubercle are a fraction of these and are infre-

The supraglenoid tubercle is located on the craniodistal aspect
of the scapula, on the craniodorsal aspect of the glenoid cavity
and is the point of origin of the biceps brachii muscle. It has a
separate centre of ossification from the rest of the scapula and
does not fuse with the body of the scapula until between
12 weeks and 6 months of age in dogs, depending on breed.1,2
Fractures of the scapula represent 0.5 to 2.4% of all fractures in
small animals and 2.4% of fractures in dogs.3,4 Fractures of the
Andrew J. C. Beer's ORCID is https://orcid.org/0000-0002-3179-
1509.
quently encountered. Supraglenoid tubercle fractures are
articular and classified as type III fractures.3
Hyperflexion of the shoulder results in increased tension
on the biceps tendon and a supraphysiological force is
exerted on the supraglenoid tubercle resulting in fracture.
In skeletally immature, large breed dogs this can be caused by
a hard fall, although it is reported that due to the weakness of
the physis even minor trauma can result in avulsion.5 In
skeletally mature dogs, fracture of the tubercle does occur;
however, a greater traumatic force is required.
Acutely these fractures often cause a high-grade lame-
ness. The severity of the lameness resolves rapidly, but a

received © 2019 Georg Thieme Verlag KG DOI https://doi.org/

September 21, 2018 Stuttgart · New York 10.1055/s-0039-1688777.
accepted after revision ISSN 0932-0814.
March 19, 2019
342 Supraglenoid Tubercle Fractures Kulendra et al.
lower grade lameness can persist chronically as a result of
osteoarthritis, malunion or non-union.5,6
Due to forces that the biceps brachii attachment is
exposed to, flexion of the shoulder following fracture of
the supraglenoid tubercle will further displace the fragment.
Typically fracture displacement is not more than 10 mm
distally due to the transverse humeral ligament.7 Sponta-
neous healing is unlikely as the fragment distraction and
constant pull from the biceps prevents secondary bone
healing and open reduction and internal fixation is often
indicated.5
Several methods for surgical stabilization of supragle-
noid tubercle fractures are described: fixation using a pin
and tension band wire; an interfragmentary screw in a lag
fashion; excision of the fragment combined with perform-
ing a biceps brachii tenodesis or tenotomy.8 Recommenda-
tion for the management of acute injuries is open reduction
and internal fixation, and, for chronic injuries, fragment
removal with or without concurrent biceps tenodesis.2 For
comminuted fractures plate application may be more
appropriate than a pin and tension band wire or interfrag-
mentary screw, when load sharing across the fracture is not
achievable.
The supraglenoid tubercle can be approached by either an
osteotomy of the greater humeral tubercle, via a cranial
approach, or a longitudinal myotomy of the supraspinatus
muscle from its midbelly to its insertion onto the greater
tubercle of the humerus; the latter allows avoidance of an
osteotomy.9 Avoiding an osteotomy may be beneficial in
skeletally immature animals, preventing disruption of the
proximal humeral physis.10 There is a paucity of information
on the management and outcome of fractures of the supra-
glenoid tubercle in dogs.
The advice on postoperative care is controversial. Some
studies advise an early return of weight-bearing, whereas
others prefer a Velpeau or non-weight bearing sling for
2 weeks, exercise restriction and 6 to 8 weeks for gradual
return to exercise.6,11,12
A programme of physical rehabilitation is recommended
postoperatively to prevent fibrosis and decreased range of
movement.13,14
The objective of this study was to report the outcomes and
complications encountered following surgical stabilization
of fractures of the supraglenoid tubercle with different
fixation methods.
Materials and Methods
Inclusion Criteria
Cases were recruited from the Queen Mother Hospital for
Animals, Michigan State University and Veterinary Referral
Hospital Hallam between 2002 and 2016. Dogs with both
simple and comminuted fractures of the scapula involving
the supraglenoid tubercle were included. Cases with incom-
plete medical records, lack of preoperative or postoperative
radiographs, or follow-up re-examination were excluded
from the study. Medical records and radiographs of affected
cases were reviewed.
Veterinary and Comparative Orthopaedics and Traumatology Vol. 32
Animal and Fracture Description
Data collected included breed, age at presentation, chroni-
city of fracture, lameness at presentation, weight, fracture
type (simple or comminuted), presence of concurrent ortho-
paedic injuries, method of fixation, use of postoperative
coaptation, physical rehabilitation, intraoperative complica-
tions, postoperative complications, whether biceps tenot-
omy was performed, fracture reduction, follow-up physical
examination and subjective outcome from the owner or
referring veterinary surgeon.
Lameness was defined using a modified equine scale,
ranging in severity from mild (1–3/10 lame), moderate (4–
6/10 lame), severe (7–9/10 lame) to non-weight bearing (10/
10 lame).15 Postoperative complications were defined as
complications occurring in the 3 months post-treatment.16
Complications were divided into major (defined as requiring
surgical or medical treatment to resolve) and minor (did not
receive any treatment).16 All cases were re-examined at least
once by the referral hospitals. Follow-up radiographs were
obtained for all dogs that had surgical fixation of the fracture
to assess implant position and fracture healing. Where
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possible, all dogs had their lameness, shoulder range of
motion and pain assessed on each revisit.
Success was defined as radiographic union postopera-
tively, the patient having no or mild lameness (1–3/10), with
no long-term analgesia necessary. Failure was defined as an
unresolved lameness following surgical intervention, or the
patient requiring long-term non-steroidal anti-inflamma-
tory drug medication (non-steroidal anti-inflammatory
drugs).
Case Follow-Up
Where possible, the referring vets or owners were contacted
for longer term follow-up. The owners were asked to com-
plete a questionnaire, based on the Canine Brief Pain Index
(CBPI), to determine outcomes.17 Additional questions deter-
mined if long-term non-steroidal anti-inflammatory drug
therapy was required, and whether further surgery was
required to obtain a satisfactory outcome.
Data Analysis
Due to low case number descriptive analysis was performed.
All tables and median values were produced using Microsoft
Excel.
Results
Animal and Fracture Description
Twelve cases met the inclusion criteria (►Table 1). Eleven
cases had surgery performed, with one managed conserva-
tively. All 12 cases were closed fractures. Dog breeds
included Bernese Mountain Dog (n ¼ 1), Briard (n ¼ 1),
Cavalier King Charles Spaniel (n ¼ 1), Cocker Spaniel
(n ¼ 2), Jack Russell Terrier (n ¼ 1), Newfoundland
(n ¼ 1), Siberian Husky (n ¼ 2), Staffordshire Bull Terrier
(n ¼ 1), Weimaraner (n ¼ 1) and mixed breed (n ¼ 1).
Median age was 41 months (4–108 months) and median
body weight was 22.4 kg (11.5–38.6 kg). The duration of the
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 Table 1 Summary of the 12 cases of dog’s with supraglenoid tubercle fractures and their management

Case Breed Sex Age Chronicity Lameness Fracture type Concurrent Fixation Coaptation Physical Intraopera- Postoperative Follow-up physi- Follow-up Successful
number (months) (days) at orthopaedic and time (w) therapy tive compli- radiographs cal examination radiographs outcome
presenta- injuries cations (time [post-op] (time [post-
tion and findings) op] and find-
ings)

1 Mixed 84 1 Non-weight Comminuted N 2x plates, pin Carpal flexion Y N Satisfactory frac- 2w- mild decrease 6w- implants Y
bearing and tension bandage (2w) ture reduction and in ROM of shoulder stable, frac-
band wire implant 6w- 2/10 lame- ture line
positioning ness, normal ROM reduced
of shoulder 6mo-
5mo- no lameness, implants
normal ROM of stable, frac-
shoulder ture healed
1y- pain on
shoulder manipu-
lation and biceps
tendon palpation
(bicipital tenosy-
novitis diagnosed
arthroscopically)

2 Cocker FN 60 1 Severe Comminuted N Pin and ten- Velpeau sling Y N Satisfactory frac- 6w- 3/10 lameness 6w- implants Y
Spaniel sion band (2w) ture reduction and and decreased stable, frac-
wire and K implant ROM of shoulder, ture line visi-
wires positioning muscle atrophy ble, bony
12w- no lameness, remodelling
slight decreased of fracture
ROM of shoulder, 12w- implants
muscle atrophy stable, frac-
5y- acute 3/10 ture healed
lameness, 5y- migration
decreased ROM of of pins under
shoulder (mana- supraspinatus
ged conservatively
and resolved,
implants left in
place)

3 Bernese M 15 1 Non-weight Comminuted Y T plate and Carpal flexion N Regurgitation Near anatomic 2w- no crepitus on 2w- implant N
Mountain bearing pin and ten- bandage (4w) alignment shoulder manipu- failure, frac-
Dog sion band lation but some ture displace-
wire pain ment and
non-union

4 Stafford- 83 2 Non-weight Comminuted N Pin and ten- None N N Good fracture 2w- 3/10 lame- 8w- implants Y
shire Bull bearing sion band reduction and ness, mild pain on stable, frac-
Terrier wire implant shoulder manipu- ture line visi-
positioning lation ble but
8w- 3/10 lame- reduced
ness, no pain on
shoulder manipu-
lation
12w- no lameness,
Supraglenoid Tubercle Fractures

normal ROM of

Veterinary and Comparative Orthopaedics and Traumatology

shoulder

5 Siberian 5 3 Moderate Simple N Lag screw and Velpeau sling N N Satisfactory frac- 2w- no pain on 4w- implants Y
Husky anti-rotation (4w) ture reduction and shoulder manipu- stable, frac-

Vol. 32
wire implant lation, normal ture line visi-
positioning ROM of shoulder, ble but
mild muscle atro- reduced
phy
Kulendra et al.

No. 4/2019
(Continued)
343

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 344

Table 1 (Continued)

Case Breed Sex Age Chronicity Lameness Fracture type Concurrent Fixation Coaptation Physical Intraopera- Postoperative Follow-up physi- Follow-up Successful
number (months) (days) at orthopaedic and time (w) therapy tive compli- radiographs cal examination radiographs outcome
presenta- injuries cations (time [post-op] (time [post-
tion and findings) op] and find-
ings)

4w- 3/10 lame-

ness, normal ROM
of shoulder joint,
moderate muscle
wastage
10w- 2/10 lame-
ness, normal ROM
of shoulder

6 Briard F 6 3 Moderate Simple N Pin and ten- Velpeau sling N N Satisfactory frac- 6w- 1/10 lame and 6w- implants Y
sion band (2w) ture reduction and discomfort on stable, frac-
Supraglenoid Tubercle Fractures

wire implant flexion of shoulder ture line visi-

positioning with elbow ble
extended, muscle 10w- implants
atrophy stable, frac-

Veterinary and Comparative Orthopaedics and Traumatology

10w- no lameness ture line visi-
or pain ble but
16w- no lameness reduced

Vol. 32
or pain
Kulendra et al.

7 Cavalier FN 93 3 Moderate Comminuted N Pin and ten- Velpeau sling N N Satisfactory frac- 1w- 8/10 lameness 1w- implants N
King sion band and carpal ture reduction and 6w- 4/10 lameness stable but
Charles wire and K bandage tried implant 11w- acute severe increased
Spaniel wires but not positioning pain, suspected fracture gap

No. 4/2019
tolerated implant failure,
euthanasia

8 Weimaraner F 108 4 Severe Comminuted Y Lag screw None N N Good fracture 8w- 3/10 lame, 8w- implants Y
reduction and normal ROM of stable, frac-
implant shoulder, muscle ture line
positioning atrophy visible

9 Cocker M 4 8 Variable Simple N Pin and ten- Velpeau sling Y N Satisfactory frac- 2w- accessory car- 2w- implants Y
Spaniel sion band (2w) ture reduction and pal pad sloughed, stable, frac-
wire implant normal ROM of ture healing
positioning shoulder 4w- fracture
4w- 2/10 lame- healed
ness, normal ROM
of shoulder

10 Siberian 22 21 Mild Simple N None None N N/A N/A 4w- no lameness, None Y
Husky normal ROM of
shoulder

11 Newfound- 7 91 Moderate Simple Y Fragment None N N None 2w- 2/10 lame- None Y
land removal and ness, normal ROM
biceps of shoulder
tenotomy 6w- no lameness,
normal ROM of
shoulder

12 Jack Russell FN 60 1642 Severe Simple N Fragment None N N Severe osteoar- 2w- 4/10 lame- None N
Terrier removal thritic changes of ness, decrease
shoulder joint, ROM of shoulder
complete removal 4w- 4/10 lame-
of fragment ness, decrease
ROM of shoulder

Abbreviations: F, female; FN, female neutered; M, male; mo, months; N, no; post-op, postoperative; ROM, range of motion; w, weeks; Y, yes; y, years.

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 Supraglenoid Tubercle Fractures Kulendra et al. 345

Fig. 1 Preoperative (A) and postoperative (B) lateral radiographs of a patient (case 9) with a simple fracture of the supraglenoid tubercle
repaired using a pin and tension band wire. Two weeks postoperative radiographs (C) show the implants are stable and fracture is healing.

fracture ranged from 1 day to 1,642 days, with the median placed in a Velpeau sling; three for 2 weeks, one for 4 weeks
being 3 days. Lameness varied from mild to completely non- and another initially placed in a Velpeau sling, but it was
weight bearing. The median lameness grade was moderate. removed as the dressing was not tolerated, two cases had the

Downloaded by: Uppsala University. Copyrighted material.

Six fractures were simple, with the other six being com-
minuted. Three of the cases had concurrent orthopaedic
injuries including one case each of humeral luxation, scap-
ular spine fracture and acromial avulsion. Of the skeletally
immature dogs (4/12), all four had simple fractures. The
supraglenoid tubercle, a separate centre of ossification, had
not yet fused in these four dogs resulting in physeal fractures.
The fractures were treated as follows: 5/12 with a pin and
tension band wire (►Fig. 1A–C); 2/12 with screws placed in a
lag fashion (one with an anti-rotational wire and one with-
out) (►Fig. 2A–C); 2/12 with plates and screws in addition to
a pin and tension band wire (►Fig. 3A–D); 2/12 had a salvage
procedure consisting of fragment removal; 1/12 case was
managed conservatively (►Fig. 4). Immediate postoperative
radiographs were assessed in all cases with surgical fixation
(n ¼ 9). Fracture reduction and implant positioning was
classified as either satisfactory (n ¼ 6), good (n ¼ 2) or
near anatomic (n ¼ 1).
The cases were managed postoperatively with a range of
coaptation methods. Five had no coaptation, five had the limb
limb placed in a carpal flexion bandage; one for 2 weeks and
one for 4 weeks. Three cases had physical therapy post-
operatively and nine did not.
Ten out of 11 surgically treated cases had no intraopera-
tive complications, with one case suffering from regurgita-
tion. Postoperatively all surgically treated cases incurred
complications, two major (cases 3 and 7) and nine minor
(cases 1, 2, 4, 5, 6, 8, 9, 11 and 12).
Outcome
Five out of six of the dogs with simple fractures had a
successful outcome and four out of the six of the dogs with
comminuted fractures had a successful outcome. Implant
failure was seen in one dog with and one dog without
concurrent injuries (cases 3 and 7 respectively) (►Table 1).
Both cases of lag screw fixation (n ¼ 2) had a successful
outcome (cases 5 and 8). Of the five dogs treated using a pin
and tension band wire, four had successful outcomes (cases
2, 4, 5 and 9); however, one dog suffered from implant failure
11 weeks postoperatively (case 7). One of the two cases

Fig. 2 Preoperative (A) and postoperative (B) lateral radiographs of a patient (case 5) with a simple fracture of the supraglenoid tubercle
repaired using a lag screw and an anti-rotation wire. Four weeks postoperative radiographs (C) show the implants are stable and fracture gap is
reduced but still visible.

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346 Supraglenoid Tubercle Fractures Kulendra et al.

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Fig. 3 Preoperative (A) and postoperative (B) lateral radiographs of a patient (case 1) with a comminuted fracture of the supraglenoid tubercle
repaired using two string of pearls plates and a pin and tension band wire. Six weeks postoperative radiographs (C) show the implants are stable
and fracture gap is reduced. Six months postoperative radiographs (D) show the implants are stable and the fracture healed; note the irregular
proliferative bone changes and increase in mineral opacity of the intertubercular groove.

repaired with a plate and a pin and tension band wire had a
successful outcome, but the other suffered from implant
failure 2 weeks postoperatively (cases 1 and 3 respectively).
Of the two dogs treated with fragment removal, one had a
successful outcome; the other had a 4/10 lameness 4 weeks
postoperatively (cases 11 and 12 respectively). The latter
case was reported to still have issues with mobility 2 years
after initial case management likely due to the extensive
osteoarthritic changes evident when the case presented;
however, follow-up radiographs were not obtained. The
one case managed conservatively (n ¼ 1) had a successful
outcome (case 10). This case presented 21 days after the
fracture occurred and remodelling of the fracture was
already evident radiographically. Lameness had resolved
by 4 weeks; however, no longer term follow-up was
available.
Postoperative Complications
The major complications diagnosed were one case with
implant failure, fracture displacement and non-union of
the fracture 2 weeks postoperatively (case 3) and one case
with severe acute pain and suspected implant failure
11 weeks postoperatively leading to euthanasia (case 7).
The minor complications seen were seven cases of mild
lameness (cases 1, 4, 5, 6, 8, 9 and 11), one case of moderate
lameness (case 12), three cases of decreased range of move-
ment of the shoulder (cases 1, 2 and 12) and one bandage-
related injury (case 9). Both cases that suffered implant
failure were skeletally mature (2/2) (cases 3 and 7). For
one case with implant failure (case 3), revision surgery
was discussed with the owners but they were reluctant so
opted to attempt conservative management. One case (case
1) represented with pain on palpation of biceps tendon and

Veterinary and Comparative Orthopaedics and Traumatology Vol. 32 No. 4/2019


Fig. 4 Lateral radiograph of a patient (case 10) with a simple fracture
of the supraglenoid tubercle. This case presented 21 days after the
trauma and the radiograph shows the fracture already remodelling.
This case was managed conservatively and lameness resolved after
4 weeks.
shoulder manipulation 1 year postoperatively. Radiographs
revealed irregular proliferative bone changes and increase in
mineral opacity of the intertubercular groove; bicipital
tenosynovitis was diagnosed arthroscopically.
Follow-Up
The owner response to the questionnaire was 5/12. Of the
five respondents, three cases were deemed a success (cases 1,
2 and 8) and two cases were deemed a failure (cases 3 and
12). Median follow-up time was 2 years, six months post-
surgery (11 weeks–8 years).
In the three successful cases, a median pain score of 2/10
(range, 0–4) was reported. In all three successful cases, pain
was not seen to be interfering with enjoyment of life. Pain
was not seen to interfere with walking and running in two
cases (cases 2 and 8), with one case being 1/10 affected for
walking and 2/10 affected for running (case 1). All three
successful cases were viewed to have an excellent quality of
life and required no further surgery or long-term non-
steroidal anti-inflammatory drugs.
One of the three successful cases (case 2) was reported to
have some interference with rising (3/10) and difficulties
climbing upstairs (7/10). The median scores for the three
successful cases for interference with activity, enjoyment of
life, rising, walking, running, and climbing were all 0/10
(range, 0–7).
Supraglenoid Tubercle Fractures Kulendra et al. 347
Of the two failed cases (cases 3 and 12), the median score
for average pain and pain at its least was 5/10, with pain at its
worst having a median score of 8.5/10. It was found that pain
interfered with both dog’s activity, enjoyment, rising and
running (cases 3 and 12). Only one owner felt that the pain
interfered with the dogs walking and climbing (case 3).
Discussion
There is a distinct paucity of information in the peer-
reviewed literature regarding outcome following supragle-
noid tubercle fractures with the vast majority of the infor-
mation available existing in textbooks and review
articles.2–9,11,12
All four of the skeletally immature dogs in this study
(n ¼ 4) were large breeds and had simple avulsion fractures,
supporting previous observations recorded in the litera-
ture.11 Simple fractures had a higher success rate and lower
major and minor complication rates compared with the
comminuted fractures. This is perhaps not unexpected as
fixation of simple fractures has a lower reported complica-
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tion rate than fixation of comminuted fractures.18 This is
speculated to be due to the fact that simple fractures are
easier to reconstruct anatomically compared with commin-
uted fractures which permit greater load sharing between
the bone and implant.
Due to the limited case number, it is difficult to determine
which method of fracture fixation resulted in a better out-
come. The method of fixation is influenced by multiple
factors including fragment size, degree of comminution
and surgeon preference.
It has been reported that a high success rate can be
achieved when repairing supraglenoid tubercle fractures
with a 2.0 mm T plate.19 It was shown to provide a robust
fixation with a very few complications; however, plate
fixation can only be used if the fragment is of sufficient
size to allow implant placement.
Current literature recommends to place a screw, remove
the fragment or place a pin and tension band wire for simple
fractures with limited information in the literature on the
treatment of comminuted fractures.2,5,6,9 To place a screw,
the fragment must be large enough to ensure that it does not
fracture. If the fragment is too small to accommodate an
appropriately sized lag screw, a pin and tension band wire
would be indicated. However, for very small fragments
conservative management or fragment removal may be
indicated as was done in 3/12 dogs in this series.
Chronically lame cases were treated by fragment removal,
in line with the current recommendations in the literature.2
Although the initial lameness associated with these fractures
is severe, this resolves rapidly and many patients may not be
presented by their owner until the lameness is chronic,
possibly due to osteoarthritis associated with malunion or
non-union of the fracture.5
Only one case was managed conservatively in this study so
it is difficult to establish the success of this as an option for
fracture management. Fragment removal could have been
considered in this case if lameness and pain progressed due
Veterinary and Comparative Orthopaedics and Traumatology Vol. 32 No. 4/2019
348 Supraglenoid Tubercle Fractures Kulendra et al.
to osteoarthritic changes of the shoulder joint. Current
literature states that surgical management of these cases is
required to achieve a satisfactory outcome; however, it is
possible that conservative management may be appropriate
in some cases.5,6,20 If anatomic reconstruction is not possible
and rigid fixation of these fractures cannot be achieved, then
a salvage option may be required. Further investigation of
fragment removal as a potential treatment option is war-
ranted in cases of chronic fractures or where the fragment is
too small for reattachment.
Fractures of the supraglenoid tubercle in the horse have
been reported to be stabilized with a distal femoral locking
plate cranial to the scapular spine or one or two transversely
placed locking compression plates, although these pieces of
literature involved small case numbers.21,22 It would appear
that plate fixation is a robust method of fixation if the
fragment size is large enough in dogs and has been shown
in one study to have a high successful outcome.19
Of the two cases that had implant failure, one was fixed
with a combination of T plate and a pin and tension band
wire. The plate was used due to the severely comminuted
fracture and was necessary to reconstruct the fragments. The
implant is speculated to have failed due to excess force being
applied to the implants; this was likely due to suboptimal
reduction, preventing load sharing and excessive force on
relatively weak implants.
In the other case of implant failure, a pin and tension
band wire were used in conjunction with Kirschner wires.
The size of the fragments only allowed for pin placement.
As this fracture was comminuted, the implant probably
failed due to tension on the repair placed by the biceps’
tendon. It can be speculated that in both cases performing a
tenodesis or tenotomy of the biceps brachii may have
eliminated the pull of the tendon on the repair, potentially
preventing implant failure. For both cases of implant failure
arthrodesis of the scapulohumeral joint was recommended
but declined by the clients in both instances. Arthrodesis
has been reported to eliminate lameness caused by mal-
union or severe degenerative osteoarthritis secondary to a
fracture.7
Given the limited case number, it is difficult to make any
definitive conclusion about the effects of postoperative
coaptation in this case series. The aim of postoperative
coaptation is to decrease the tension on the biceps tendon
by keeping the elbow in flexion, in turn reducing tension on
the fracture fixation.23 Postoperative coaptation varied
greatly between cases based on surgeon preference. Unfor-
tunately, due to the retrospective nature of this multi-
centre study, an inherent limitation of the study was the
variability of fixation and postoperative management tech-
niques. The low incidence of this fracture type necessitated
a retrospective multi-centre study to achieve sufficient
numbers.
Cases with no concurrent injuries were shown to have a
higher success rate than cases with concurrent injuries,
although the cases with no concurrent injuries had a higher
minor and total complication rate. This could be due to the
small sample size or the fact that patients with concurrent
Veterinary and Comparative Orthopaedics and Traumatology Vol. 32
injuries will be more likely to have extended periods of cage
rest, preventing complications such as implant failure or
non-union. The presence of concurrent injuries can impact
on the ability of a surgeon to use external coaptation. A
Velpeau sling or carpal flexion bandage, which do not allow
weight bearing, is more difficult to use in patients with
severe injuries affecting other limbs that may be non-weight
bearing for a period of time.
Unfortunately, there was limited follow-up for all cases.
One case was diagnosed with bicipital tenosynovitis 1 year
postoperatively; a complication that has previously been
reported after fixation of supraglenoid tubercle frac-
tures.19,24 Due to the articular nature of the fracture, an
increased incidence of osteoarthritis of the shoulder joint is
expected.3 One case that presented around 4.5 years after the
fracture occurred was found to have severe osteoarthritic
changes of the shoulder.
Limitations of this study include the retrospective nature
and small sample size. There is a heterogeneity in the
fracture types, timing of intervention and therapies chosen
that make it difficult to draw firm conclusions from the
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study.
The lameness score at presentation was a subjective
assessment method applied by multiple different surgeons;
a standardized lameness assessment or force plate analysis
could be used for more objective measures.25
Although a validated questionnaire, the response rate of
the owners to the CBPI was poor. Another limitation of study
design was that the time between surgery and questionnaire
completion varied greatly potentially allowing a greater time
for osteoarthritis and other postoperative complications
such as implant migration to occur in some patients com-
pared with others.
Conclusion
This study has found a variety of options exist for repair of
supraglenoid tubercle fractures; however, the limited num-
ber of cases in this series makes interpretation difficult. The
study has highlighted a collective lack of knowledge in the
small animal orthopaedic field regarding fractures of the
supraglenoid tubercle and indicates that further research is
needed into this area to confirm the optimal fixation method
to minimize complications and ultimately reduce fixation
failures.
Author Contribution
Elvin R. Kulendra contributed to conception of study,
study design, acquisition of data and data analysis and
interpretation. Andrew J. C. Beer contributed to study
design, acquisition of data and data analysis and inter-
pretation. George C. A. Hockley, Derniese Goh, Pilar
Lafuente, and Karen Perry contributed to acquisition of
data and data analysis and interpretation. All authors
drafted, revised and approved the submitted manuscript.
Funding
None.
No. 4/2019

Conflict of interest
None declared.
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Veterinary and Comparative Orthopaedics and Traumatology Vol. 32 No. 4/2019