Retrospective cohort of 3018 primary reverse total shoulder arthroplasties from two high-volume centers. It asks whether inlay versus onlay humeral component design affects the risk of postoperative acromial and scapular spine fractures. It also characterizes the prevalence, timing, and Levy classification of these fractures.
When a reverse shoulder patient develops new shoulder pain in the first postoperative year, think periscapular fracture. This cohort shows 81% present within 12 months, most involving the acromion. The practical decision point: inlay versus onlay stem choice should not be driven by fracture fear. Across 3018 shoulders, the rates were statistically identical (2.6% vs 2.0%).
This contradicts earlier smaller series (Haidamous 2020) that reported higher scapular spine fracture rates with onlay stems. The debate is not fully settled, but the larger data favors no meaningful difference. Risk instead tracks with the patient: older women, thin osteoporotic acromion, prior rotator cuff repair, and prior acromioplasty. Counsel these patients accordingly.
Management is overwhelmingly nonoperative (94%), with abduction immobilization for 6 weeks. Reserve ORIF for recalcitrant symptoms or displaced scapular spine fractures.
Retrospective cohort of 3018 primary reverse total shoulder arthroplasties from two high-volume centers. It asks whether inlay versus onlay humeral component design affects the risk of postoperative acromial and scapular spine fractures. It also characterizes the prevalence, timing, and Levy classification of these fractures.
When a reverse shoulder patient develops new shoulder pain in the first postoperative year, think periscapular fracture. This cohort shows 81% present within 12 months, most involving the acromion. The practical decision point: inlay versus onlay stem choice should not be driven by fracture fear. Across 3018 shoulders, the rates were statistically identical (2.6% vs 2.0%).
This contradicts earlier smaller series (Haidamous 2020) that reported higher scapular spine fracture rates with onlay stems. The debate is not fully settled, but the larger data favors no meaningful difference. Risk instead tracks with the patient: older women, thin osteoporotic acromion, prior rotator cuff repair, and prior acromioplasty. Counsel these patients accordingly.
Management is overwhelmingly nonoperative (94%), with abduction immobilization for 6 weeks. Reserve ORIF for recalcitrant symptoms or displaced scapular spine fractures.