internal fixation has been shown to successfully prevent recurrent dislocations after fractures of the glenoid rim . with regards to fixation complications regarding suture anchors and their management have been described previously but not the arthroscopic management of screw impingement . we present a case of a 70 year old women who suffered from limited range of motion after fixation of a ideberg iii fracture using cannulated screws . x - rays showed one of the screws to be proud . the proud screw could be successfully removed arthroscopically resulting in an improved range of motion , function and decreased pain . our report describes a possible technique for performing a procedure arthroscopically that used to be done as an open procedure before and highlights it 's limitations . fractures of the glenoid rim have been reported as a frequent complication of anterior shoulder dislocation . nonoperative treatment can result in the development of shoulder osteoarthritis , and recurrent shoulder dislocations has been observed in 80% of patients treated with nonsurgical methods . therefore , operative treatment is the current standard and was shown to successfully prevent further dislocation and accelerated wear . internal fixation can be achieved either by open surgery using screw fixation of the avulsed fragment using a subscapularis - split- or an inverted - l - approach   or arthroscopically using either cannulated screws   or suture anchors in a technique similar to bankart repair for recurrent dislocation . when cannulated screws are used , metalware impingement can occur in up to 40% of patients as a retrospective study by scheibel et al showed . while techniques for the removal of proud suture anchors after glenoid refixation   have been described as well as the removal of cannulated screws and washers from within the knee , there are no reports about arthroscopic removal of cannulated screws of the glenoid . we present a case of a 70 year old woman where arthroscopic metalware removal was undertaken for a displaced cannulated screw after fixation of a bony glenoid rim lesion . the patient has given consent that data concerning her case would be collected for publication . she had been treated with hemiarthroplasty as well as cannulated screws for a glenoid fracture ( ideberg iii ) after fracture - dislocation of the left shoulder . 6 months postoperatively , the patient 's abduction was 80 and forward flexion was 70 , respectively . 18 months postoperatively , the patient presented for follow - up complaining about a sudden loss of range of motion without further trauma . pain was rated as 6 out of 10 and the patient 's constant score was 15 . on examination , active and passive range of motion were decreased , both in abduction ( 30 ) and forward flexion ( 30 ) . tests were negative for instability , rotator cuff deficiency , subacromial and subcoracoidal impingement as well as for pathology of the long head of the biceps . x - rays showed a radiolucent lesion of the inferior glenoid and displacement of one of the cannulated screws ( fig . arthroscopic examination showed metallic debris around the head of the clearly deformed cranial screw as well as scratch marks on the surface of the shoulder prosthesis and diffuse synovialitis . impingement of the screw with the humeral head replacement could be visualized when moving the shoulder in abduction . the rotator cuff and the long head of the biceps tendon were found to be intact . a kirschner wire was inserted using the 5-oclock portal and the cannulated screw was localised . the wire was inserted into the screw and a cannulated screw driver was used to remove the screw through a stab incision ( fig . the inferior screws were well buried and left in place as they could not be accessed arthroscopically due to their position . intraoperatively , range of motion was 70 for abduction and 60 for forward flexion after screw removal and careful manipulation . given the patient 's range of motion before impingement occurred the decision was taken not to release the joint capsule . pre - operative x - ray demonstrating the proud head of the anterior cannulated screw . a ) during arthroscopy , the cannulated screw could be successfully located with a kirschner wire and then b ) removed with a cannulated screw driver . postoperatively , a mobilisation programme using a suprascapular block and nonsteroidal analgetics for pain relief was begun . exercises focussed on stretching the inferior capsule and improving strength the humeral head depressors in order to centralize the prosthetic humeral head . 6 weeks after surgery , abduction and forward flexion were 80 and 70 , respectively . refixation of fragments of the glenoid rim is a commonly performed procedure . with regards to fixation devices , both screws [ 3,4 , 11,12 ] and suture anchors a high incidence of complications related to metalware has been described for open surgery using cannulated screws . in a study by scheibel et al , 40% of patients treated with cannulated suffered from screw impingement or loosening . raiss et al   report a rate of 27.5% of patients that needed to undergo revision surgery for screw removal . although the rate of complications related to screws has not been reported yet after arthroscopic fixation of anterior glenoid rim fracture , it can be assumed that , due to implant size , the overall incidence could be as high as reported for open technique . kokubu et al presented a case report of an anterior rim fracture treated with a double - threaded headless compression screw . this seems to be a promising technique as the screw can be placed under the cartilaginous surface , preventing impingement of a prominent screw 's head therefore . arthroscopic surgery has been recommended not only for fracture fixation but also for management of complications regarding metalware . in 2009 , jeong and shin   presented a case series describing successful arthroscopic removal of proud suture anchors after bankart repair . none of their patients showed redislocation or instability . visual analogue score for pain and constant score improved significantly . in our experience , the anterior glenoid rim was well accessible using a 5-oclock portal trying to localize the cannulated screws with the standard kirschner wire also used for insertion . due to its small diameter , it was impossible though to use it for levering in order to advance it into the more distal screws as it would bend . in the presented case , the patient sustained a fracture classified as ideberg iii , separating the lower third of the glenoid from the joint . in a patient with an anterior glenoid fracture ( ideberg i ) , screws in the commonly used positions would have been easily accessible using arthroscopic standard portals . when performing internal fixation for ideberg iii fractures , a technique inserting the cannulated screws from superior to inferior should be considered therefore . arthroscopic screw insertion using this technique has been described using the neviaser portal , but there are no reports of arthroscopic screw removal after this procedure yet . in our patient 's case therefore , removal was not necessary . in case of impingement of the more inferior screws , an open procedure would have been necessary . the main advantage of performing the procedure arthroscopically is to avoid a subscapularis - detaching approach . both the inverted - l- and subscapularis - splitting - approach have been shown to violate the integrity of the muscle , resulting in fatty degeneration causing a loss of muscle power and susceptibility to muscle tears . another advantage is that prolonged restriction of external rotation can be avoided . due to the patient 's limited range of motion , the range of motion achieved by surgery could be maintained postoperatively by starting stretching exercises early after surgery , using a suprascapular block for pain control . the procedure can be performed easily for screws positioned in the anterior rim but , in our experience , screws positioned in the inferior glenoid can not be localised percutaneousely without putting neurovascular structures at risk . the main advantage of performing the procedure arthroscopically was avoiding the morbidity and possible complications of an open approach and allowing to start physiotherapy early . whether arthroscopic screw removal has significant advantage with regards to shoulder function , recurrence of instability and patient comfort needs to be subject of clinical studies . a loose screw from glenoid fracture fixation can present as sudden loss of range of motion and pain . these screws if present in the anterior quadrant can be removed using an arthroscope with technique described here
introduction : internal fixation has been shown to successfully prevent recurrent dislocations after fractures of the glenoid rim . with regards to fixation either suture anchors or screws can be used , depending on the fragment size . 
 complications regarding suture anchors and their management have been described previously but not the arthroscopic management of screw impingement.case report : we present a case of a 70 year old women who suffered from limited range of motion after fixation of a ideberg iii fracture using cannulated screws . 
 x - rays showed one of the screws to be proud . the proud screw could be successfully removed arthroscopically resulting in an improved range of motion , function and decreased pain.conclusion:our report describes a possible technique for performing a procedure arthroscopically that used to be done as an open procedure before and highlights it 's limitations .