Scapular Neck Fractures Research Articles

Minimally Invasive Combined Medial and Lateral Approach for Treating Displaced Scapular Body and Neck Fractures.

BACKGROUND Traditional open surgery for displaced scapular body and neck fractures often results in significant trauma and complications. This study aimed to assess the efficacy of a combined medial and lateral minimally invasive approach compared with the traditional Judet approach. MATERIAL AND METHODS A retrospective analysis was conducted on 36 patients (22 men, 14 women; mean age 45.6 years) with displaced scapular body and neck fractures treated between May 2016 and May 2022. Nineteen patients underwent the minimally invasive approach, while 17 received the traditional Judet approach. Primary outcomes included surgical incision length, intraoperative blood loss, complication rate, time to postoperative pain relief (VAS score ≤3), and Constant-Murley shoulder score at 12 months. Statistical analysis was done using the t test and chi-square test. RESULTS The minimally invasive group had shorter incision lengths (mean difference: 10.0 cm; 95% CI: 8.1-11.9; P<0.001) and lower blood loss (mean difference: 129.4 mL; 95% CI: 119.0-139.8; P<0.001). They also experienced faster pain relief (mean difference: 3.0 days; 95% CI: 2.5-3.5; P<0.001) and higher Constant-Murley scores (mean difference: 7.4 points; 95% CI: 4.9-9.9; P<0.001). There were no significant differences in operative duration or fracture healing time. CONCLUSIONS The combined medial and lateral minimally invasive approach offers superior outcomes in reducing incision length, blood loss, complications, and pain, with enhanced shoulder function, making it a safe and effective alternative to the traditional Judet approach.

Morphometric Analysis of Glenopolar Angle of the Scapula in Indian Population.

The glenopolar angle (GPA),usually ranges from 30° to 45°. GPA measures the tilt of the plane of the glenoid cavity in relation tothe axis of the body of the scapula passing from the superior pole of the glenoid cavity to the inferior angle of the scapula.It is essential to assess the results of surgeries for dislocated shoulders. Worse long-term outcomes can arise from glenoid misalignment in scapular neck fractures. When evaluating prognosis and planning therapy for shoulder injuries including scapular fractures, GPA assessment is essential. Still, there is a dearth of data on the normal range of GPA and its contributing elements, which calls for more study. The purpose of this study is to determine typical GPA values by utilizing radiographs and a sizable sample of scapular bone specimens. In this study, the GPA was assessed in 50 chest radiographs of anteroposterior (AP) view and Neer's view of individuals as well as 100 dried scapulae of any gender. The mean GPA obtained using the various methods was then statistically compared. All scapulae had an average GPA of 42.6°. Twenty-ninescapulae had GPA observations higher than 45°, with an average of 47.2°. Twenty-seven scapulae had GPA measurements below 40°, averaging 37.3°.Right-sided 62 scapulae with an average GPA of 43.1°were present. Thirty-eight of left-side scapulae had a GPA of 41.7° on average. It was determined that the 1.6° mean difference in GPA between the two groups was not statistically significant. The Kolmogorov-Smirnov test verified that the GPA data had a normal distribution. The homogeneity of variances across various measuring techniques was confirmed using Levene's test. The average GPA measured using the dry scapula approach was 42.6°, the average GPA measured using the AP view was 39.8°, and the average GPA measured using the Neer I view was 42.3°. The GPA means from these three approaches differed considerably (p=0.0014) according to a one-way Analysis of Variance (ANOVA). Fisher's least significant difference post hoc testing showed thatthe scapular bone specimens and the Neer I view revealed significantly higher GPA values than AP shoulder radiographs.The GPA values obtained from the osteological group and the Neer I perspective had a mean difference of 0.21°, which was practically identical and suggested that there was no statistically significant difference between these approaches. In order to diagnose and treat a variety of shoulder joint diseases, this study estimates the normal values of scapular GPA. Furthermore, it offers support for improved implant design in the context of Indian shoulder joint replacement and repair.Using every measurement technique, the GPA values on the right and left sides did not differ significantly.GPA results from various measuring methods varied significantly, which emphasizes the significance of methodological consistency in clinical and research settings.

Finite element analysis of the treatment of a minimally invasive approach combined with a novel anatomical locking plate for scapular body fractures

BackgroundThe minimally invasive approach for the treatment of displaced scapular neck or body fractures has the advantages of less trauma and minimal muscle dissection. In clinical practice, the minimally invasive approach combined with an anatomical locking plate has been used to treat scapular body fractures. In addition, we have made minor modifications to the minimally invasive approach. However, the biomechanical study about the approach combined with an anatomical locking plate in treating scapular body fractures was limited.MethodsFinite element analysis (FEA) was used to conduct the biomechanical comparison between the anatomical locking plate (AP model) and reconstructive plate (RP model) in the treatment of scapular body fractures through the modified minimally invasive approach. A healthy male volunteer with no history of scapula or systemic diseases was recruited. High-resolution computed tomography images of his right scapula were obtained. Two scapula models were constructed and analyzed by the software of Mimics 21.0, Geomagic Wrap 2021, SolidWorks 2021, and ANSYS Workbench 2022, respectively.ResultsThrough static structural analysis, in terms of equivalent von Mises stress, equivalent elastic strain, and total deformation, the AP model exhibited superior safety characteristics, enhanced flexibility, and anticipated stability compared with the RP model. This was evidenced by lower maximum stress, lower maximum strain and displacement.ConclusionThe minimally invasive approach combined with an anatomical locking plate for scapular body fractures had better biomechanical stability. The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures.

Treatment options and outcomes for delayed scapular anatomical neck fractures: a case report and review of the literature

IntroductionScapular anatomical neck fractures are among the most infrequent shoulder girdle fractures. Only seven radiologically confirmed cases of scapular anatomical neck fractures have been documented in the literature to date, of which only one case underwent delayed surgery.Case presentationA 34-year-old male Persian patient with morbid obesity was diagnosed with a scapula anatomical neck fracture after a motor vehicle collision. The radiographic assessment of the patient indicated an increase in the scapular glenopolar angle (73.9°). Due to concurrent chest and head injuries, surgical intervention was deferred until 6 weeks following the injury. The posterolateral limited Dupont–Evrard approach was used because of the patient’s extremely high body mass index. Two plates were utilized to achieve stable fixation of the glenoid neck fracture. Following a 1 year follow-up period, complete fracture union was successfully attained, resulting in a constant score of 79.ConclusionsThe most accurate radiographic indicators of these fractures are a superior fracture line located laterally to the coracoid process, a small inferior spike, and an elevated glenopolar angle. The only tendon attached to the glenoid is the long head of the triceps, making these fractures unstable; therefore, surgery is required in the majority of instances. The small size of the fractured component makes stabilization more difficult. Overall, anatomical scapular neck fractures are extremely uncommon and distinguished from other scapular fractures by their unique radiological and biomechanical characteristics. This case highlights the challenges encountered when managing scapular fractures in patients with morbid obesity. The delayed surgical intervention and the choice of surgical approach tailored to the patient’s specific anatomical and physiological considerations proved to be effective in achieving a favorable outcome.

Three-Dimensional Mapping of Scapular Body, Neck, and Glenoid Fractures.

The purpose of this study was to report patterns of scapular fractures and define them with a contemporary methodology. . Retrospective study, 2015-2021. Single, academic, Level 1 trauma center. Consecutive patients ≥18 years, presenting with unilateral scapula fracture, with thin-slice (≤0.5-mm) bilateral computed tomography (CT) scans of the entirety of both the injured and uninjured scapulae. Thin-slice (0.5-mm) CT scans of injured and normal scapulae were obtained to create three-dimensional (3D) virtual models. 3D modeling software (Stryker Orthopedics Modeling and Analytics, Stryker Trauma GmbH, Kiel, Germany aka SOMA) was used to create a 3D map of fracture location and frequency. Fracture zones were delineated using anatomic landmarks to characterize fracture patterns. Eighty-seven patients were identified with 75 (86%) extra-articular and 12 (14%) intra-articular fractures. The dominant fracture pattern emanated from the superior lateral border (zone E) to an area inferior to the spinomedial angle (zone B) and was present in 80% of extra-articular fractures. A second-most common fracture line propagated from the primary (most-common) line toward the inferior medial scapular border with a frequency of 36%. Bare zones (with 1 or no fractures present) were identified in 4 unique areas. Furthermore, intra-articular fractures were found to be heterogenous. The 3D fracture map created in this study confirmed that extra-articular scapular fractures occur in certain patterns with a relatively high frequency. Results provide greater insight into scapular fracture locations and may help to study prognosis of injury and improve treatment strategy including operative approaches and surgical tactics.

Which scapula fractures should we operate on and what are the functional outcomes?

Aim: In this study we reported the functional results and complications of patients with scapula fractures who underwent open reduction and internal fixation. Methods: The study included 16 patients with scapula fractures who were treated with open reduction and internal fixation(ORIF) between September 2015 and March 2022. Radiologic examination (AP in the scapular plane, lateral and axillary radiography) and computed tomography (CT) scans were performed in all patients. Fractures were classified according to the revised (AO/OTA) classification system. The patients underwent deltopectoral and posterior approaches described by Judet. Functional outcomes were measured using Constant-Murley scores. Results: Ten patients had a scapular neck fracture, or glenoid fossa fracture, five patients had a scapular trunk fracture affecting the glenohumeral joint, and one patient had a scapula process fracture. It was accompanied by clavicle shaft fracture in five patients. The mean follow-up period after injury was 42 months (6-92 months). The mean Constant-Murley score (CMS) for the shoulder with scapula fracture was 93.8 (±8.93). Conclusion: Open reduction and internal fixation of displaced scapular fractures is an effective treatment option in terms of union rate and functional outcome.

Novel Claw-shaped Bone Plate in Complex Unstable Scapular Neck and Body Fractures: Comparison with Reconstruction Locking Plate.

For complex and unstable scapular fractures requiring simultaneous fixation of the glenoid neck, the lateral margin of the body, and/or the scapular diaphysis, reconstruction locking plate is difficult to achieve satisfactory fixation. In order to optimize the fixation effect, the newly designed claw-shaped bone plate was designed for fixing such fractures. We also evaluate the clinical effects and follow-up at an average of 1 year after treatment in scapular internal fixation by using reconstruction locking plate and claw-shaped bone plate in complex unstable scapular body and glenoid neck fracture. A retrospective study was conducted from 2018 to 2021, thirty-three patients (27 males and six females) who were defined unstable scapular fractures by Ada-Miller. Fifteen patients (52.86 ± 8.26 years) received claw-shaped bone plate and 18 cases (51.61 ± 11.31 years) received reconstruction locking plate with the intermuscular approach. The clinical effect was evaluated based on the operation time, intraoperative blood loss, surgical complications, clinical healing time and Constant-Murley score (CMS). The data analysis by Student t, Mann-Whitney U test and Pearson's chi squared test. Compared with reconstruction locking plate, the claw-shaped bone plate showed shorter operation time (102.73 ± 18.43 min vs. 156 ± 37.53, P < 0.0001), higher CMS (94.00 ± 4.07 vs. 89.88 ± 5.42, P = 0.02) and no differences between the two groups regarding intraoperative blood loss (208.00 ± 96.45 mL vs. 269.44 ± 120.21, P = 0.12) and clinical healing times (9.96 ± 1.52 vs. 10.05 ± 1.67, P = 0.87). Follow-up were conducted at first, third, 6 and 12 months after surgery. The operation was successful in all patients with no intraoperative complications. For the treatment of complex and unstable scapular neck body fractures, the application of claw-shaped bone plate demonstrated short operation time, better stability of the fracture block, and higher CMS. In the intraoperative and postoperative follow-up showed better clinical results and rehabilitation effects.

Finite element analysis of a novel anatomical locking plate for scapular neck fracture

ObjectivesReconstruction plates (RPs) are commonly used in scapular neck fractures (SNFs): however, RPs have many defects. In this study, we evaluated a newly designed scapular neck anatomical locking compression plate (SNALCP).MethodsAn SNF finite element model (Miller-type IIB) was constructed. Plates were subsequently implanted into the scapula and fixed with screws that were grouped according to the plate used: SNALCP (A) and RP (B). Finally, loads were applied to record and analyze performance.ResultsUnder lateral, anteroposterior, and vertical compression loads, the maximum von Mises stresses on the scapula and implants of group A were smaller than those of group B. There were some differences in stress distribution between the two groups.ConclusionsSNALCP can effectively reduce the stress of the scapula and implant, making stress distribution more uniform and continuous, and has mechanical conduction advantages. Compared to RP, it provides improved stability and more reliable fixation.

Stability, Deformity and Fixation of the Floating Shoulder: A Cadaveric Biomechanical Study.

Floating shoulder injuries cause instability and deformity due to disruptions of the scapula, clavicle and superior shoulder suspensory complex (SSSC) ligaments. Resulting deformity of the glenopolar angle (GPA) has not previously been established, nor has the impact on stability and deformity when surgical fixation is performed. This study sought to quantify stability and deformity for multiple injury patterns, and the improvement to these parameters provided by clavicle and coracoclavicular (CC) ligament fixation. Fourteen cadaveric specimen upper extremities were used, which included the entire upper extremity, scapula, clavicle and cranial-most ribs. After being mounted upright, a scapular neck fracture was created, followed by either a midshaft clavicle fracture or sectioning of the acromioclavicular (AC) and coracoacromial (CA) ligaments. Subsequent sectioning of the other structure(s) followed by the CC ligaments was then performed. In all specimens the clavicle was then plated, followed by a CC ligament repair. At each step, a radiograph in the AP plane of the scapula was taken to measure GPA, and displacement of the glenoid fragment using radiopaque markers placed in the scapula. These radiographs were taken both unloaded and with a 100N applied medializing force. When evaluating deformity related to sectioning, the GPA was reduced when the CC ligaments were sectioned compared to an isolated scapula fracture (p=0.022) and compared to a combined scapula and clavicle fracture (p=0.037). For stability, displacement with a 100N force was significantly increased when the CC ligaments were sectioned compared to an isolated scapula fracture (p=0.027). In cases of an ipsilateral scapula neck and clavicle fracture with intact ligaments, fixation of the clavicle alone provided a statistically significant improvement in GPA (p=0.002); but not in reduction of displacement (p=0.061). In cases of an ipsilateral scapula neck and clavicle fracture with concomitant disruption of the CA, AC and CC ligaments, GPA was improved by clavicle fixation (p<0.001), and increasingly so by subsequent CC ligament repair (p<0.001). Displacement was also improved in these two states respectively (p<0.001, p=0.008). This biomechanical study confirmed the importance of the AC, CA and CC ligaments in conferring stability in SCCC injuries. Disruption of the CC ligaments created significant deformity of the GPA and instability with a medializing force. Clinical treatment should consider the integrity of these ligaments and their repair in conjunction with clavicle fixation, knowing that this combination should restore a biomechanical state equivalent to an isolated scapula fracture.

A study of the role of locking plates in management of fracture of scapula in adults at tertiary health care center

This study aimed to evaluate the functional outcome of displaced scapular neck, glenoid and body fractures treated by open reduction and internal fixation by locking plate. In this study 10 patients of scapular fracture (neck, glenoid and body) were treated with locking plate at Dr. Hedgewar hospital, Aurangabad from January 2014 to December 2020 with age from 18 to 60 years. Functional outcome was evaluated by Constant-Murley scoring system. Total 10 patients were included in present study. Mean age of the patients was 44.9±11.06 years. Male patients (80%) were common than female patients (20%). Road traffic accident (80%) was most common mode of injury. In fracture type distribution, neck and body of scapula (90%) fracture was most common. Assessment of shoulder function was done using Constant and Murley scoring system. Good function was noted in 80% patients, followed by excellent function in 10% patients and fair function was noted in 10%. Open reduction and internal fixation of displaced scapular (neck, glenoid or body) fracture with locking plate provides good functional outcome.

Scapular Fractures at a Level 1 Trauma Center: A Cross-Sectional Study.

Purpose: Scapular fractures are uncommon injuries that account for up to 1% of all fractures and 5% of all shoulder girdle fractures. Moreover, most of the evidence on the treatment of scapular fractures stems from case series, with paucity of comparative studies. Despite the lack of standardized criteria for the operative treatment of scapular fractures, a set of suggested radiological parameters has been recently reported. The primary aim of this study was to compare the treatment implemented for scapular fractures in comparison with standard published criteria. The secondary aim was to investigate epidemiological parameters of scapular fractures at a level 1 trauma center.Methods: In this cross-sectional study of scapular fractures at a level 1 trauma center, data were collected between December 2012 and January 2016. Data of all scapular fractures that presented to our center were retrospectively collected through electronic medical records. Identified cases of scapular fractures were then evaluated whether surgical treatment was indicated in accordance with recent standard operative criteria. Percentages were used to express the number of cases that were operatively indicated according to the predefined criteria and the number of cases operatively treated at our institution.Results: A total of 52 patients met the inclusion criteria of having scapular fractures documented on radiography and Computed tomography (CT). The mean age of the patients was 38.5 years, with the majority being men (92.3%). The most common mechanism of injury was a fall from a considerable height in 26% of the cases. Of the included patients, 53.8% were polytraumatized, and the most frequent concomitant traumatic injury was rib fractures (26.9%). Only 33% of intra-articular glenoid fractures with significant displacement were treated operatively. Furthermore, non-operative treatment was undertaken in indicated extra-articular scapular body and neck fractures, acromion or coracoid process fractures, or superior shoulder suspensory complex double disruptions.Conclusion: A significant discrepancy was found between the treatments implemented at our institution and the current standard criteria for the operative treatment of scapular fractures. This study emphasizes the need to educate surgeons on scapular fractures and to treat such fractures in accordance with standard published criteria. Furthermore, scapular fractures that require surgery should be referred to a surgeon experienced in scapular fracture fixation.

Diagnosis and Treatment of Scapular Fractures in Children and Adolescents: A Critical Analysis Review.

Fractures of the growing scapula account for about 0.1% of all pediatric fractures, with the majority occurring at an age of ≥10 years. Radiographic diagnosis requires a detailed knowledge of the ossification sequence of the growing scapula. Computed tomography examination is indicated for displaced fractures of the glenoid fossa, the scapular neck, and complex fractures; magnetic resonance imaging should be performed in cases of suspected injury to the physis and with stress fractures, depending on patient age and the potential need for general anesthesia during the scanning process. Separation of the base of the coracoid process is often associated with acromioclavicular dislocation. Clavicular fractures rarely occur in combination with injuries to the growing scapula. The majority of scapular fractures can be treated nonoperatively. Indications for surgery are displaced intra-articular fractures, scapular neck fractures with a displacement of >2 cm, coracoid base separation associated with acromioclavicular dislocation, and scapulothoracic dissociation. Displaced intra-articular fractures of the glenoid fossa should be followed after healing until skeletal maturity. Complications are rare and occur most frequently with scapulothoracic dissociation.

Influence of coracoglenoid space on scapular neck fracture stability: biomechanical study

BackgroundThe anatomical variation of the coracoglenoid space has the potential to influence the stability of scapular neck fractures. This paper aimed to investigate the mechanical mechanism underlying the influence of different coracoglenoid space types on scapular neck fractures by morphometric analysis and biomechanical experiments.MethodsThe morphology of 68 dried scapulae (left: 36; right: 32) was studied. Two variables, the length of the coracoglenoid distance (CGD) and the coracoglenoid notch (CGN), were measured. The distribution of CGN/CGD × 100% was used to identify the morphology of the coracoglenoid space. Each specimen was tested for failure under static axial compression loading. The average failure load, stiffness, and energy were calculated.ResultsTwo coracoglenoid space types were identified. The incidence of Type I (‘‘hook’’ shape) was 53%, and that of Type II (‘‘square bracket’’ shape) was 47%. The CGD and CGN were significantly higher for type I than type II (13.81 ± 0.74 mm vs. 11.50 ± 1.03 mm, P < 0.05; 4.74 ± 0.45 mm vs. 2.61 ± 0.45 mm, P < 0.05). The average maximum failure load of the two types was 1270.82 ± 318.85 N and 1529.18 ± 467.29 N, respectively (P = 0.011). The stiffness and energy were significantly higher for type II than type I (896.75 ± 281.14 N/mm vs. 692.91 ± 217.95 N/mm, P = 0.001; 2100.38 ± 649.54 N × mm vs. 1712.71 ± 626.02 N × mm, P = 0.015).ConclusionsThere was great interindividual variation in the anatomical morphology of the coracoglenoid space. Type I (hook-like) spaces bore lower forces, were less stiff, and bore less energy, which may constitute an anatomical predisposition to scapular neck fractures.

Double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle for treatment of floating shoulder injuries

To investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries. Between January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function. All incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly ( P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores ( P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%. Double internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.

Functional Outcome of Open Reduction and Internal Fixation of Displaced Extra-Articular Scapula Fractures

Scapular fractures are uncommon injuries of upper extremity resulting mostly from high-energy trauma. Extra-articular fractures form the majority of them. Un-displaced fractures can be managed conservatively with good results. But displaced fracture does not yield satisfactory results and needs surgical fixation. In this case series, we report our experience about such fractures. This was a retrospective study of 12 patients with displaced scapular body and neck fractures treated between 2015 and 2018. Scapular fractures were exposed by modified Judet approach and fixed with either 3.5mm T buttress or recon locking plate and screws. One case had associated clavicle fracture which was fixed along with scapula. Patients were put on structured rehabilitation and followed up regularly. Functional outcome and range of motion were analyzed. The patients included 10 males and two females. Mean age was 42years. Average follow-up was 33months. Average constant and Murley score was 80. Excellent results were seen in four patients, good results in seven patients and one patient has got fair result. The mean post-operative range of motion of the shoulder at the time of final follow-up was 140° of forward flexion, 136° of abduction, and 34° of external rotation. Displaced extra-articular scapular fractures managed by internal fixation using T buttress locking plates and reconstruction plates give good functional outcome.

Reverse Total Shoulder Arthroplasty with a Superior Augmented Glenoid Component for Favard Type-E1, E2, and E3 Glenoids.

Uncorrected superior glenoid wear in patients managed with reverse total shoulder arthroplasty (rTSA) can result in increased complications, including baseplate failure. The present study quantifies the clinical and radiographic outcomes of patients with Favard type-E1, E2, and E3 glenoid deformity who were managed with rTSA with use of a superior or superior/posterior augmented glenoid baseplate. We retrospectively reviewed the records for 68 patients with shoulder arthritis and Favard type-E1, E2, or E3 glenoid deformity who were managed with primary rTSA and a 10° superior augmented or 10° superior/8° posterior augmented baseplate. The mean duration of follow-up was 40 months (range, 24 to 85 months). Outcomes were assessed preoperatively and at the latest follow-up with shoulder range of motion and use of outcome scores including the Simple Shoulder Test (SST), University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Shoulder Pain and Disability Index (SPADI) score. Radiographs were evaluated preoperatively and at the time of the latest follow-up. Differences in preoperative and postoperative range of motion and outcome metrics were assessed with use of a 2-tailed Student t test. The majority of patients experienced clinically meaningful improvements in terms of pain and function following rTSA with a superior or superior/posterior augment, with 94% of patients rating themselves as "much better" (73.5%) or "better" (20.5%) at the time of the latest follow-up. At least 88% of the patients exceeded the minimum clinically important difference (MCID) threshold, and 75% of patients exceeded the substantial clinical benefit (SCB) threshold, for each of the clinical outcome metrics and range of motion. Five complications were reported (prevalence, 7.4%), including acromial stress fracture (2 patients), posttraumatic scapular neck fracture (1 patient), chronic shoulder pain (1 patient), and aseptic glenoid loosening (1 patient). The present short-term clinical and radiographic study demonstrated that shoulder arthropathy with superior glenoid wear patterns (Favard types E1, E2, and E3) can be successfully treated with rTSA with a superior or superior/posterior augmented baseplate. Longer-term clinical and radiographic follow-up is necessary to confirm that these promising short-term results are durable. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Can displaced extra-articular fractures of the scapula be stabilized through a direct lateral-column approach

BackgroundDisplaced extraarticular fractures of the scapula are uncommon, and rarely require operative fixation. When managed operatively, a posterior Judet approach with detachment of the deltoid muscle from the scapular spine and elevation of the infraspinatus from its fossa, is often performed. This approach is invasive and involves extensive soft tissue dissection. This paper describes the utility of single-column fixation with a direct lateral column approach, with mobilisation of the deltoid, and elevation of the interval between the infraspinatus and teres minor. Our aim is to assess the functional and radiological outcomes of this alternative approach. MethodsWe performed a retrospective cohort study of all patients who underwent operative fixation of their extra-articular scapula fracture (with at least 12 months follow up), using the direct lateral-column approach. Operative indications included patients with an extra articular scapular neck or body fracture, with medial/lateral displacement of ≥20 mm, angulation ≥45°, double disruption of the shoulder suspensory complex, and glenopolar angle (GPA) ≤ 22°. Functional outcomes were assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Subjective Shoulder Value (SSV), pain score & return to work. Radiological assessment was done by 2 independent assessors. ResultsBetween January 2014 and December 2016, 12 patients (11 males and 1 female) underwent fixation of their scapula fracture using this approach. Eleven patients (91.7%) returned their questionnaire at an average of 15.6 months (12–28 months). All fractures had healed at the time of the final follow-up. The scapular neck angulation was corrected from 38.7° pre-operatively (0–74°) to 3.6° post-operatively (0–20°). The mean post-operative GPA was 35.4° (30.2°–42.0°). None of the patients had superficial or deep infections, or post-operative neurovascular injuries. Two patients underwent elective removal of their clavicle hook plates. The mean SSV was 88.9 (70–100) and mean pain score was 1.5 (0–8). The mean DASH score was 11.4 (0–51.6). Ten patients returned back to their pre-injury work, with an average return to work of 3.3 months (2 weeks–8 months). Only one patient had a poor DASH score. He had associated ipsilateral segmental fracture of the humerus, fracture of the lateral clavicle and brachial plexus injury. ConclusionsThe direct lateral-column approach is an alternative technique for fixation of the extra-articular neck and body scapular fracture. Plating of the lateral column of the scapula through this single approach is associated with correction of scapular angular deformity, no complications and good clinical results at more than 12 months’ follow-up.

Long-term Functional Outcomes of Nonoperatively Treated Highly Displaced Scapular Body and Neck Fractures.

Historically, extra-articular scapular body fractures were treated nonsurgically, but displaced fractures of the glenoid neck can lead to dysfunction. Controversy exists regarding which extra-articular scapular fractures should be treated surgically; however, nonsurgical management of severely displaced scapular body fractures can result in satisfactory outcomes. Inclusion criteria for this study were medial or lateral displacement greater than 2 cm, angular deformity between fracture fragments greater than 45°, or glenopolar angle less than 22°. Functional outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) score, Short Form-36 (SF-36) score, and American Shoulder and Elbow Surgeons (ASES) shoulder score. Radiographs and computed tomography scans were available for all patients. Range of motion (ROM), strength, other injuries, and complications also were recorded. Twelve patients (10 males, 2 females) with a mean age of 45.6 years (range, 29-57 years) underwent follow-up for a mean of 54.1 months (range, 28.2-74.4 months). At latest follow-up, mean DASH score was 8.9 (range, 0-35), mean SF-36 score was 72.2 (range, 57.3-96.1), and mean ASES score was 85.9 (range, 46.7-100). Mean ROM and strength expressed as a percentage of the contralateral side ranged from 88% to 99% and 70% to 93%, respectively. At longest follow-up, 10 patients reported excellent satisfaction with their treatment. There were no radiographic non-unions. One patient with concomitant clavicle and acromion fractures treated surgically had a postoperative infection requiring operative irrigation and debridement. None of the patients required or sought additional treatment. Nonoperative treatment of highly displaced scapular body fractures resulted in good patient satisfaction, satisfactory long-term functional outcomes, and only minor loss of motion and strength. [Orthopedics. 2020;43(3):e177-e181.].

Outcomes following extra-articular fractures of the scapula: A systematic review

BackgroundScapular neck and body fractures are typically treated nonoperatively, with operative treatment traditionally focused on intraarticular fractures or double disruptions of the shoulder suspensory complex. The objective of this study was to systematically examine and compile the existing literature in regard to operative and conservative treatment of extraarticular fractures of the scapula. MethodsA comprehensive search of multiple electronic databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to find outcome data on fractures of the scapular neck and body. All studies from 1988 to 2018 that met inclusion criteria were reviewed independently and graded based on the modified Coleman Methodology Score. Outcomes of interest were compiled and analyzed for adjusted means. Results42 manuscripts with a total of 669 patients were included for analysis from an initial search of 335 results. There was an average age of 41.2 years, 78.1% were male, 98.8% had a blunt force mechanism, and 66.7% had other injures outside the scapula at time of presentation. In total, there were 120 patients with scapular body fractures, 95 with scapular neck fractures, 130 with floating shoulder injuries including a scapular neck or body fracture, and 324 with an unspecified extraarticular scapular fracture. 464 patients were treated operatively, with a mean union rate of 99.4%, Constant score of 84.4, and end forward elevation of 158°. 205 total patients were treated non-operatively, with a mean union rate of 85.1%, Constant score of 79.0, and end forward elevation of 153°. ConclusionPatients with extraarticular fractures of the scapula have excellent outcomes following either nonoperative or operative management. There is a need for high quality comparative studies to determine the optimal treatment strategy for these injuries.

Infraglenoid fracture of the scapular neck − fact or myth?

In 1991, Ada and Miller described anew type of scapular neck fracture. It was atransverse fracture of the scapular body passing from the inferior border of the glenoid to the medial border of the scapular body (their type IIC). This fracture was later designated by Goss as a&#8220;fracture of neck inferior to scapula spine&#8220;. Since then, this type of fracture has been the cause of anumber of controversies, mainly concerning the so-called &#8220;floating shoulder&#8221;. However, scapular neck fractures can be considered to be only those fractures that separate completely the glenoid from the scapular body. Term &#8220;fracture of neck inferior to scapula spine&#8220; does not fit into this definition because it does not compromise the junction between the glenoid fossa and the scapular body. Actually, it is atransverse two-part fracture of the infraspinous part of the scapular body. As aresult this term should no longer be used in the literature.