Radiographic follow-up of 84 operatively treated scapula neck and body fractures.
BACKGROUND
Certain scapula fractures may warrant surgical management to restore shoulder anatomy and promote optimal function. The purpose of this study is to determine the early radiographic follow-up of open reduction internal fixation (ORIF) for displaced, scapular fractures involving the glenoid neck and body.


METHODS
Eighty-four patients with a scapula body or neck fracture (with or without articular involvement) underwent ORIF between 2002 and 2010 at a single level I trauma centre. This study represents a retrospective review of data prospectively collected into a dedicated scapula fracture database. All patients met at least one of the following operative criteria: ≥20 mm medial/lateral (M/L) displacement (lateral border offset), ≥45° of angular deformity on a scapular-Y X-ray, the combination of angulation ≥30° plus M/L displacement ≥15 mm, double disruptions of the superior shoulder suspensory complex both displaced ≥10 mm, glenopolar angle (GPA) ≤22° and open fractures. Eighty-eight percent (74/84) had sufficient follow-up defined as at least 6 months. Measured outcomes included rates of scapula union and malunion, as well as surgical complications and re-operations.


RESULTS
All fractures were caused by high-energy trauma with 24 (29%) resulting from motor-vehicle collisions. Associated injuries occurred in 94% of patients, most commonly involving the chest (70%) and ipsilateral shoulder girdle (43%). Forty-eight patients had M/L displacement as an operative indication with a mean displacement of 25.7 mm (range=20-40). Thirty-eight (45%) had ≥2 operative indications. A single surgeon performed ORIF in all patients using a posterior approach. Five patients also required an anterior (deltopectoral) approach. The fixation strategy included lateral and vertebral border stabilisation with dynamic compression and reconstruction plates, respectively. Union was achieved in all cases. There were three cases of malunion based on a GPA difference >10° from the uninjured shoulder. Re-operations included removal of hardware (seven patients) and manipulation under anaesthesia (three patients). There were no infections or wound dehiscence.


CONCLUSIONS
ORIF for displaced scapula fractures is a relatively safe and effective procedure for restoration of anatomy and promotion of union.


METHODS
Therapeutic study, level IV.
University of Minnesota/Regions Hospital, 640 Jackson Street, St. Paul, MN 55101, USA. Peter.A.Cole@HealthPartners.Com
Peter A
PA
Cole
Erich M
EM
Gauger
Diego A
DA
Herrera
Jack
J
Anavian
Ivan S
IS
Tarkin
D000293:Adolescent; D000328:Adult; D000368:Aged; D017760:Bone Malalignment / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D017759:Fractures, Malunited / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012540:Scapula / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult