title: Scapula insufficiency fractures after reverse total shoulder arthroplasty in rotator cuff arthropathy: What is their functional impact?
abstract: To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy.
  
  
  METHODS
  A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D).
  
  
  RESULTS
  The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P>.05); postoperative Constant score: 81.2 and 66.5%, respectively (P>.001). Forward elevation and abduction in fracture patients decreased by 39° (P=.02), and 34° (P=.057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P=.002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months.
  
  
  CONCLUSIONS
  Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication.
authors.affiliation: Unidad de Hombro y Codo, Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España. Electronic address: yaizalopiz@gmail.com.
authors.forename: Yaiza
authors.initials: Y
authors.lastname: Lópiz
authors.affiliation: Unidad de Hombro y Codo, Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodríguez-González
authors.affiliation: Unidad de Hombro y Codo, Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: García-Fernández
authors.affiliation: Unidad de Hombro y Codo, Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Marco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D015775:Fractures, Stress / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D012540:Scapula / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome
keywords: Acromial base fractures; Acromial fractures; Artroplastia invertida; Fracturas de acromion; Fracturas de escápula; Fracturas de la base del acromion; Fracturas por insuficiencia; Insufficiency Fracture; Reverse shoulder arthroplasty; Scapular fracture