Objective To compare the effectiveness of posterior axillary edge approach and arthroscopic assisted reduction in the treatment of Ideberg type Ⅰ and Ⅱ scapular fractures. Methods The clinical data of 26 patients with fresh Ideberg type Ⅰ and Ⅱ scapular fractures admitted between June 2021 and September 2024 who met the selection criteria were analyzed retrospectively. The patients were divided into two groups according to different treatment methods. Ten cases in the arthroscopic group were treated with suture anchor fixation under arthroscopy, and 16 cases in the posterior axillary edge group were fixed by open reduction plate through the posterior axillary edge approach. There was no significant difference in baseline data between the two groups (P>0.05), such as gender, age, surgical side, Ideberg type, cause of injury, time from injury to operation, rotator cuff injury, and superior labrum anterior posterior (SLAP) injury, etc. The operation time and fracture healing time were recorded and compared between the two groups, and the shoulder pain was evaluated by visual analogue scale (VAS) score at 1 week, 1 month, and 3 months after operation. At 3 and 6 months after operation, the range of motion of shoulder joint in anteflexion, abduction, external rotation, internal rotation and backward extension was evaluated, the upper limb dysfunction was evaluated by the Disability Assessment Scale of Arm, Shoulder, and Hand (DASH), and the shoulder joint function was evaluated by the Constant-Murley Scale. The changes between 6 months and 3 months after operation were statistically analyzed. ResultsPatients in both groups were followed up 11-13 months, with an average of 12.5 months. The operation time and fracture healing time in the posterior axillary edge group were significantly shorter than those in the arthroscopic group (P<0.05). There was no complication such as wound infection, vascular and nerve injury, loss of reduction, bone nonunion, and glenohumeral instability in both groups. At 1 week after operation, the VAS score in the posterior axillary edge group was significantly higher than that in the arthroscopic group (P<0.05); there was no significant difference in the VAS score between the two groups at 1 and 3 months after operation (P>0.05). At 6 months after the operation, the changes of shoulder flexion, internal rotation range of motion and DASH scores in the posterior axillary edge group were significantly lower than those in the arthroscopic group (P<0.05), while the changes of abduction, external rotation, extension range of motion and Constant-Murley scores were not significantly different between the two groups (P>0.05). ConclusionFor Ideberg type Ⅰ and Ⅱ scapular glenoid fractures, the posterior axillary edge approach for internal fixation has a short operation time, fast fracture healing, and is beneficial for early functional recovery; arthroscopic assisted reduction has minimal trauma and can handle joint injuries simultaneously. Both surgical procedures are safe and effective, and individualized selection should be made based on soft tissue conditions and combined injuries.