Friday, December 13, 2013

Scapular spine and body fractures after reverse total shoulder

What is the effect of postoperative scapular fracture on outcomes of reverse shoulder arthroplasty?

The authors conducted a retrospective, case-control study of 25 nonoperatively treated postoperative scapular fractures after reverse shoulder arthroplasty with a minimum 2-year follow-up from surgery and 1-year follow-up from fracture. 17 were of the acromion and 8 were of the scapular body.

The incidence of scapular fracture after reverse total shoulder in this series was 3.1%. Fractures occurred from 1 to 94 months postoperatively. The average time to fracture was 16 months. Only half of the fractures healed.The revision rate appeared to be higher in the fracture group than in the control group (8% vs 2%).

Fracture patients had inferior clinical outcomes, with a postoperative ASES score of 58.0 compared with 74.2 (P ≤ .001). Change in range of motion also diminished in the fracture group, with a mean gain of 26° forward elevation compared with 76° (P < .001). 

This study did not provide data on the risk factors for fracture. We observed that 21 of the 25 cases were in women, average age at surgery was 72 years, most common indication for a reverse was massive cuff tear, but these were not different than the control group. 

No information is provided on the amount of humeral lengthening, the screw placement, or low bone density - previously identified risk factors. 

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