Crosby, Clin Orthop Relat Res 2011 - Scapula Fractures after Reverse Total Shoulder Arthroplasty: Classification and Treatment

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Scapula Fractures after Reverse Total Shoulder Arthroplasty: Classification and Treatment

Crosby, Twiss, et al.·Clin Orthop Relat Res·2011·236 citations·Retrospective cohort

Free Full Text·DOI·PubMed

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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.

Purpose

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

22 patients (5.5%) had fractures.
8 (2.0%) had Type I fractures on the first followup radiographs; these patients were treated nonoperatively with resolution of symptoms.
10 (2.5%) had Type II fractures a mean of 10.8 months after RTSA; 7 of the 10 were treated surgically with improvement in their clinical symptoms.
4 (1%) had Type III fractures at a mean of 10.3 months; all 4 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.

Level of evidence: Level II, prognostic study. Copyright remains with the authors and publisher.

Scapula Fractures after Reverse Total Shoulder Arthroplasty: Classification and Treatment.

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Scapula Fractures after Reverse Total Shoulder Arthroplasty: Classification and Treatment

Crosby, Twiss, et al.·Clin Orthop Relat Res·2011·236 citations·Retrospective cohort

Free Full Text·DOI·PubMed

|

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.

Purpose

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

22 patients (5.5%) had fractures.
8 (2.0%) had Type I fractures on the first followup radiographs; these patients were treated nonoperatively with resolution of symptoms.
10 (2.5%) had Type II fractures a mean of 10.8 months after RTSA; 7 of the 10 were treated surgically with improvement in their clinical symptoms.
4 (1%) had Type III fractures at a mean of 10.3 months; all 4 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.

Level of evidence: Level II, prognostic study. Copyright remains with the authors and publisher.

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