This retrospective case-control study examined 53 scapular fractures after RSA versus 212 matched controls. It asked three questions: how sensitive are plain radiographs, how reliable is the Crosby-Hamilton classification, and what risk factors predict fracture?
A patient presents 8 months after RSA with new acromial pain and a plain radiograph that looks normal. This paper tells you not to stop there — plain films miss roughly 1 in 5 confirmed fractures, and 17 patients in this series had no visible fracture at initial presentation.
The practical workflow: compare current X-rays to the first postoperative film. If the AT distance has decreased by more than a few millimeters or the acromial tilt has increased, take it seriously. Restrict the patient's motion and obtain CT to confirm or exclude the diagnosis before displacement occurs.
Counsel osteoporotic patients before RSA. They carry nearly twice the fracture risk (OR 1.97). Smoking and steroid use trended toward increased risk but were not statistically significant in this sample, so they warrant clinical awareness without firm evidence-based thresholds.
Don't change your screw technique based on the anatomic association with screw tips. The data show fractures cluster around screws, but no specific screw parameter drove the risk. The bone fails around the implant, not because of it.
This retrospective case-control study examined 53 scapular fractures after RSA versus 212 matched controls. It asked three questions: how sensitive are plain radiographs, how reliable is the Crosby-Hamilton classification, and what risk factors predict fracture?
A patient presents 8 months after RSA with new acromial pain and a plain radiograph that looks normal. This paper tells you not to stop there — plain films miss roughly 1 in 5 confirmed fractures, and 17 patients in this series had no visible fracture at initial presentation.
The practical workflow: compare current X-rays to the first postoperative film. If the AT distance has decreased by more than a few millimeters or the acromial tilt has increased, take it seriously. Restrict the patient's motion and obtain CT to confirm or exclude the diagnosis before displacement occurs.
Counsel osteoporotic patients before RSA. They carry nearly twice the fracture risk (OR 1.97). Smoking and steroid use trended toward increased risk but were not statistically significant in this sample, so they warrant clinical awareness without firm evidence-based thresholds.
Don't change your screw technique based on the anatomic association with screw tips. The data show fractures cluster around screws, but no specific screw parameter drove the risk. The bone fails around the implant, not because of it.