Abstract
ABSTRACT BACKGROUND: The surgical management of scapula body, neck and glenoid fractures remains a challenge. This study focuses on templating an available anatomical pre-contoured plating system using three-dimensional (3D)-printed scapulae to assess the ability of these plates to address the aforementioned fractures and to determine consensus on classifying scapula body, neck and glenoid fractures. METHODS: We used a cohort of 22 3D-printed scapulae prototypes and an available anatomical pre-contoured plating system to determine anatomical congruency and fit. Nine investigators templated the scapulae using four pre-contoured plates, and the investigators classified the 22 scapulae using the Ideberg and AO/OTA classification system. RESULTS: Eleven out of 22 fractures were found to be fixable using the plates under study. The long lateral plate addressed 83% of fractures involving the lateral border, while the glenoid plate was unable to adequately address any glenoid fractures. We observed good to excellent (p < 0.001) interobserver reliability for three of the four plates. The interobserver reliability was moderate (ICC = 0.74) for the AO/OTA classification and good (ICC = 0.88) for the Ideberg classification. CONCLUSION: We believe that the anatomical pre-contoured plating system does not address all the fracture patterns encountered in clinical practice and further development in plate design is required. There is good to moderate interobserver reliability using the Ideberg fracture classification for intra-articular fractures and the AO/OTA classification for extra-articular fractures involving the body. Level of evidence: Level 3 Keywords: scapula fracture, open reduction and internal fixation (ORIF), South Africa, scapula plate analysis, 3D printing, fracture classification
Highlights
Isolated scapula fractures are rare, accounting for 3–5% of upper limb fractures and 0.7% of all fractures.[1-3]
Eleven out of 22 fractures were found to be fixable using the plates under study
We believe that the anatomical pre-contoured plating system does not address all the fracture patterns encountered in clinical practice and further development in plate design is required
Summary
Isolated scapula fractures are rare, accounting for 3–5% of upper limb fractures and 0.7% of all fractures.[1-3]. They commonly occur in the polytraumatised patient and are generally associated with significant trauma. The scapula plays a pivotal role in maintaining the resting position of the shoulder girdle and, together with the clavicle, provides the anchor for the upper limb to the thorax.[3]. The aim of scapula fracture management should be to restore shoulder function by correcting alterations in anatomy that cannot be compensated for.[3]. The surgical management of scapula body, neck and glenoid fractures remains a challenge.
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