Session XII - Upper Extremity

Sat., 10/7/06 Upper Extremity, Paper #68, 3:24 pm

Early Surgical Results of 73 Glenoid Neck/Scapula Body Fractures

Peter A. Cole, MD (a); Diego A. Herrera, MD (n); Ivan S. Tarkin, MD (n);
University of Minnesota, St. Paul, Minnesota, USA

Purpose: Although conservative treatment may lead to satisfactory outcomes after scapula fracture, certain high-energy fracture patterns deserve a more aggressive management strategy to restore shoulder anatomy and promote optimal function. The purpose of this study is to determine the early results of open reduction and internal fixation for displaced unstable scapula fractures involving the glenoid neck and or body.

Materials/Methods: Strict radiographic criteria were used to determine candidacy for operation. Surgical indications included glenoid medialization >1.5 cm and/or severe angular deformity defined as a flexion deformity >25° or a glenopolar angle <25°. Intra-articular glenoid fractures, in combination with scapula neck and/or body involvement, were also offered operative treatment. Measured outcomes included rates of scapula union, malunion, and specific complications related to operation.

Results: A consecutive series of 73 patients including 58 men and 15 woman ages 16-68 (average 40) met inclusion for the study and were managed operatively. All fractures were the result of high-energy trauma, with a majority of cases the result of a motor vehicle accident (77%). Associated injuries were common, occurring in 78% of patients, especially involving the ipsilateral shoulder girdle (49%) and chest (50%). The most prevalent indication for operation in this patient cohort was glenoid medialization averaging 2.8 cm in 37 patients. 23 patients were managed surgically for restoration of severe angular deformity (average sagittal deformity 33°, average glenopolar angle 23), with or without significant glenoid medialization. 13 patients underwent operation for glenoid articular fracture with concomitant glenoid neck and scapula body involvement. A single surgeon performed all operations using primarily a posterior exposure and 2.7-mm implants to achieve fracture reduction and fixation. The most common fixation strategy included lateral and vertebral border stabilization with a dynamic compression and reconstruction plates, respectively. Union was achieved in all cases. Using stringent radiographic criteria, malunion occurred in only one case. One major complication of a postoperative hematoma under the infraspinatus flap eventuated in compartment syndrome. In three cases, nerve injury (2 suprascapular, 1 axillary) was detected postoperatively, but it was impossible to determine whether the etiology was due to the injury itself or iatrogenic. Minor complications included hardware irritation requiring removal (2), ectopic bone formation (1), painful scar (1), and stiffness necessitating manipulation (3).

Conclusion: Osteosynthesis is a safe and effective procedure for restoring scapula anatomy and promoting fracture union.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.