title: Scapula fractures after reverse total shoulder arthroplasty: classification and treatment.
abstract: BACKGROUND
  Reverse total shoulder arthroplasty (RTSA) implants have been developed to treat patients with deficient rotator cuffs. The nature of this procedure's complications and how these complications should be managed continues to evolve. Fractures of the scapula after RTSA have been described, but the incidence and best methods of treatment are unclear.
  
  
  OBJECTIVE
  We therefore (1) determined the incidence and (2) developed a classification system intended to suggest the best choice of treatment.
  
  
  METHODS
  We reviewed the records of 400 patients treated with RTSA over 4.5 years and identified all patients with scapula fractures. We identified three discrete patterns: avulsion fractures of the anterior acromion (Type I); fractures of the acromion posterior to the acromioclavicular joint (Type II); and fractures of the scapular spine (Type III).
  
  
  RESULTS
  Twenty-two patients (5.5%) had fractures. Eight (2.0%) had Type I fractures on the first followup radiographs; these patients were treated nonoperatively with resolution of symptoms. Ten (2.5%) had Type II fractures a mean of 10.8 months after RTSA; seven of the 10 were treated surgically with improvement in their clinical symptoms. Four (1%) had Type III fractures at a mean of 10.3 months; all four fractures were treated with surgical fixation with healing.
  
  
  CONCLUSIONS
  Scapula fracture is a relatively common complication of RTSA. Our observations suggest Type I fractures can be observed with a likelihood of symptom relief. For Type II fractures, we recommend acromioclavicular joint resection if stable but open reduction internal fixation if unstable. We believe Type III fractures are best treated with open reduction internal fixation.
  
  
  METHODS
  Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedics, Medical College of Georgia, 1120 15th Street, BP 2108, Augusta, GA 30912, USA. lycrosby@mail.mcg.edu
authors: Lynn A
authors: LA
authors: Crosby
authors: Adam
authors: A
authors: Hamilton
authors: Todd
authors: T
authors: Twiss
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005845:Georgia; D006801:Humans; D008297:Male; D009820:Ohio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012540:Scapula / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology; D013708:Tendon Injuries / Q000601:surgery*; D009626:Terminology as Topic; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome