Minimally invasive plate osteosynthesis (MIPO) for scapular fractures.

Abstract

Presentation of aminimally invasive surgical approach for the treatment of scapular fractures and the clinical outcome using this technique. Displaced extra-articular fractures of the scapula body and glenoid neck (AO 14B and 14F) and simple intra-articular fractures of the glenoid. Complex intra-articular fractures and isolated fractures of the coracoid base. Make astraight or slightly curved incision along the lateral margin of the scapula leaving the deltoid fascia intact. Identify the interval between the teres minor muscle and infraspinatus to visualize the lateral column, whilst retracting the deltoid to visualize the glenoid neck. Reduce and align the fracture using direct and indirect reduction tools. Asecond window on the medial border of the scapula can be made to aid reduction and/or to augment stability. Small (2.0-2.7 mm) plates in a90° configuration on the lateral border and, if required, on the medial border are used. Intra-operative imaging confirms adequate reduction and extra-articular screw placement. Direct postoperative free functional nonweight-bearing rehabilitation limited to 90° abduction for the first 6weeks. Sling for comfort. Free range of motion and permissive weight-bearing after 6weeks. We collected data from 35patients treated with minimally invasive plate osteosynthesis (MIPO) between 2011 and 2021. Average age was 53 ± 15.1years (range 21-71years); 17had atypeB and 18atypeF fracture according the AO classification. All patients suffered concomitant injuries of which thoracic (n = 33) and upper extremity (n = 25) injuries were most common. Double plating of the lateral border (n = 30) was most commonly performed as described in the surgical technique section. One patient underwent an additional osteosynthesis 3months after initial surgery due to pain and lack of radiological signs of healing of afracture extension into the spine of the scapula. In the same patient, the plate on the spine of scapula was later removed due to plate irritation. In 2patients postoperative images showed ascrew protruding into the glenohumeral joint requiring revision surgery. After standardisation of intra-operative imaging following these two cases, intra-articular screw placement did not occur anymore. No patient suffered from iatrogenic nerve injury and none developed awound infection.