Session I - Upper Extremity

Thurs., 10/14/10 Upper Extremity, Paper #25, 2:45 pm OTA-2010

What Is the Outcome of a Protocol of Non-Operative Treatment of All Displaced Scapula Fractures?

Brent J. Bauer, MD; Robert V. O’Toole, MD; Andrew N. Pollak, MD;
Mary Zadnik Newell, OT; W. Andrew Eglseder, MD;
R Adams Cowley Shock Trauma, Department of Orthopaedics,
University of Maryland Medical School, Baltimore, Maryland, USA

Purpose: Controversy exists regarding the best treatment as authors have argued that a subset of displaced scapula fractures have poor outcomes when treated nonoperatively. At our institution, all extra-articular closed scapula fractures are treated nonoperatively. Our goal was to determine the validated patient outcomes of this protocol.

Methods: To ensure that our results were not influenced by other upper extremity injuries, we identified 421 patients with isolated scapula fractures without other injury to either upper extremity. Using published operative criteria for scapula body fractures, we evaluated 329 CT scans of surviving patients to find a subgroup of 42 patients with unilateral scapular body fractures displaced ≥1 cm from 2002 to 2007. 32 patients died and 60 patients were excluded secondary to penetrating trauma. 14 were alive for follow-up and willing to participate. The average age was 44 years (±15.8) with 86% males at an average follow-up of 50 months (range, 18-77). Outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, changes in occupation, and patient-perceived limitations as a result of shoulder injury.

Results: The average DASH score was 3.6 (range, 0-13.3), which is clinically indistinguishable from a normal shoulder. 36% scored a 0 out of a possible 100 points, indicating no evidence of ongoing upper extremity disability. 21% of patients did not know which shoulder was injured and one of those patients was confident he had never actually sustained a scapular injury despite conclusive evidence in the medical record to the contrary. None of the 14 patients reported any perceived functional limitation as a result of his or her shoulder injury.

Conclusion: In long-term follow-up, we were unable to identify any poor outcomes after nonoperative treatment of 14 consecutive displaced scapular body fractures. The DASH scores were very low, no patient changed occupation as a result of his or her shoulder injury, and no patient had any perceived limitation secondary to his or her shoulder injury. These findings suggest that nonoperative treatment of displaced scapular body fractures leads to excellent long-term results and that displacement alone should not be an indication for operative intervention. In the absence of evidence refuting these conclusions, operative treatment of displaced scapular body fractures should not be employed and a prospective randomized comparison of operative versus nonoperative treatment does not seem justifiable or otherwise warranted.

Alphabetical Disclosure Listing (292K PDF)

• 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.