This retrospective review of 400 RTSAs over 4.5 years identifies all scapula fractures and proposes a three-type anatomic classification to guide treatment. It answers two questions: how common are these fractures, and what should you do about each pattern?
Scapula fracture after RTSA was poorly characterized before this paper, with prior reports limited to small series and no treatment framework. This study is the first to systematically classify fracture patterns and link each type to a specific treatment strategy.
When a patient presents with new acromial pain after RTSA, order a CT rather than relying on plain films — 9 of 10 Type II fractures were radiographically silent at first evaluation. If you find a nondisplaced Type II fracture, do not observe: every nondisplaced Type II managed without surgery in this series eventually displaced.
At the time of RTSA, avoid placing the most superior metaglene fixation screw when possible. Three-dimensional CT confirmed it acts as a stress riser responsible for most Type III scapular spine fractures in this cohort.
This paper's classification is the reference framework for boards and clinical practice: Type I is benign and nonoperative; Type II needs AC resection if stable or ORIF if unstable; Type III requires ORIF.
This retrospective review of 400 RTSAs over 4.5 years identifies all scapula fractures and proposes a three-type anatomic classification to guide treatment. It answers two questions: how common are these fractures, and what should you do about each pattern?
Scapula fracture after RTSA was poorly characterized before this paper, with prior reports limited to small series and no treatment framework. This study is the first to systematically classify fracture patterns and link each type to a specific treatment strategy.
When a patient presents with new acromial pain after RTSA, order a CT rather than relying on plain films — 9 of 10 Type II fractures were radiographically silent at first evaluation. If you find a nondisplaced Type II fracture, do not observe: every nondisplaced Type II managed without surgery in this series eventually displaced.
At the time of RTSA, avoid placing the most superior metaglene fixation screw when possible. Three-dimensional CT confirmed it acts as a stress riser responsible for most Type III scapular spine fractures in this cohort.
This paper's classification is the reference framework for boards and clinical practice: Type I is benign and nonoperative; Type II needs AC resection if stable or ORIF if unstable; Type III requires ORIF.