Sunday, April 13, 2014

Scapular fracture in reverse total shoulder arthroplasty

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

These authors reviewed 25 nonoperatively treated postoperative scapular fractures after reverse total shoulder with a minimum 2-year follow-up from surgery and 1-year follow-up from fracture.

These cases were matched 1:4 to a control group for age, sex, follow-up time, surgery indication, and primary operation vs revision.

The rate of scapular fracture  in this series was 3.1%. Fractures occurred from 1 to 94 months postoperatively. Fracture patients had inferior clinical outcomes. In this study the outcomes were not significantly different for acromial and scapular spine fractures. The revision rate was higher in the fracture group (8% vs 2%). Only 10 of 18 fractures (55%) with greater than 1 year of radiographic follow-up showed osseous union of the fracture. The union rate was 57% (8 of 14) for acromial fractures and 50% (2 of 4) for scapular spine fractures.

This study showed that scapular fractures can occur at any point in the postoperative period, from as early as 4 weeks to nearly 8 years. The surgeon must maintain a high index of suspicion for this complication whenever a patient presents with scapular pain after reverse total shoulder arthroplasty. The diagnosis is made by careful physical exam and plain radiographs.

It has been noted previously that scapular spine fractures may occur at the site of the fixation screws.

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