Fri., 10/9/09 Upper Extremity, Paper #47, 11:28 am OTA-2009
Outcomes of Conservatively Treated Displaced Scapular Body Fractures
Apostolos Dimitroulias, MD (n); Kenneth G. Molinero, DO (n); Daniel E. Krenk, DO (n);
Matthew T. Muffly, MS (n); Daniel T. Altman, MD (n); Gregory T. Altman, MD (n);
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
Purpose: Displaced scapular body fractures are most commonly treated conservatively. However there is conflicting evidence in the literature regarding the outcomes. The purpose of this study was to investigate the results and to analyze the predictive factors that affect outcome.
Methods: We performed a prospective IRB-approved study at our Level 1 center between November 2005 and August 2008 evaluating functional outcomes of patients with scapular fractures. Of 124 consecutive patients with scapular fracture, we identified 99 patients with scapular body fracture. Of these, 53 had significant displacement (defined as fracture with at least 100% and/or 1-cm displacement). Four patients had a concomitant glenoid fracture requiring open reduction and internal fixation and were excluded. Patients with brachial plexus or other neurologic injury were also excluded from our analysis. Overall, 49 patients were treated nonoperatively. Outcome measures were radiographic and clinical (Disabilities of the Arm, Shoulder and Hand [DASH\ score). Patients were asked to rate their preinjury DASH score during their admission. DASH scores were also obtained at 6 months, 12 months, and at time of last follow-up. All patients had bilateral shoulder radiographs and CT scan with three-dimensional reconstruction of the affected scapula. Fractures were classified according to OTA classification using CT scan images. Statistical analysis was conducted through the use of multivariate analysis.
Results: 15 patients were lost to follow-up and 2 patients died, leaving 32 patients to constitute the study population. There were 16 OTA A3.1, 13 A3.2, and 3 C3 fractures. The mean follow-up was 15 months (range, 6-33). Mean age of the patients was 46.9 years (range, 21-84) and the mean ISS was 21.5 (range, 5-50). The mean preinjury DASH score was 1.5. All patients healed their fractures. The mean change of glenopolar angle (compared to the opposite side) was 9° (0°-20°). The mean change of DASH score (last DASH – preinjury DASH) was 10.2. Statistical analysis revealed significance between the change of DASH score and ISS (P = 0.02), and presence of rib fractures (P = 0.01). There was no association between the final clinical outcome and the following variables: type of fracture, change of glenopolar angle, involvement of suprascapular fossa, presence of angulation or comminution, and presence of clavicle or other ipsilateral extremity fracture.
Conclusion: Good outcomes are reported with nonoperative treatment of displaced scapular body fractures. The clinical outcome is a function of extrascapular factors, mainly the ISS and presence of rib fractures.
• 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. Δ OTA Grant