Session I - Upper Extremity


Thurs., 10/14/10 Upper Extremity, Paper #26, 2:51 pm OTA-2010

Surgical and Functional Outcomes after Operative Management of Extra-Articular Glenoid Neck and Scapula Body Fractures

Erich M. Gauger, MD; Peter A. Cole, MD;
Division of Orthopaedic Trauma, Department of Orthopaedic Surgery,
University of Minnesota, Regions Hospital, St. Paul, Minnesota, USA

Purpose: Scapula fractures are relatively rare and typically result from high-energy trauma. Some case series have suggested that a certain subset of patients benefit from open reduction and internal fixation. However, there have been no large, prospective case series critically examining the functional results with motion and strength analysis after operative management. The purpose of this study is to assess the surgical and functional results after treatment of extra-articular scapula body/neck fractures.

Methods: 72 patients (58 males and 14 females) with extra-articular fractures of the scapula were treated surgically between July 2002 and June 2009. Fractures were classified as scapula body (14-A3) or extra-articular glenoid neck (14-C1) according to the revised OTA classification. Indications for operative treatment included >20 mm medialization of the glenohumeral joint, >45° of angular deformity in the semicoronal plane, angulation >30° and medialization >15 mm, double disruptions of the superior shoulder suspensory complex displaced >10 mm, glenopolar angle <22°, and open fractures. Disabilitities of the Arm, Shoulder and Hand (DASH) and Short Form 36 (SF-36) functional outcome scores, range of motion, strength, endurance, and return to work/activities were obtained on 60 patients (83%). This group forms the study cohort for follow-up.

Results: At a mean follow-up of 25 months (range, 5.5-69.5 months), all patients demonstrated clinical and radiographic union of their fracture. There were 62 body fractures (14-A3) with 39 of 62 (63%) comminuted and 10 neck fractures (14-C1) with 9 of 10 (90%) comminuted. 25 patients (35%) had 2 or more operative indications. 28 patients (39%) had a double or triple disruption of the superior shoulder suspensory complex. Mean preoperative medialization, glenopolar angle, and angulation were 21.1 mm (range, 0-43 mm), 29.2° (range, 15°-42°), and 17.4° (range, 0°-43°), respectively. The mean DASH score at follow-up was 13.7 (range, 0-58; normative mean = 10.1). For all parameters, the mean SF-36 scores of the study patients were comparable to those of the normal population. Range of motion in degrees for the operated (O) and uninjured (U) shoulder were forward flexion: O = 153, U = 158; abduction: O = 103, U = 105; and external rotation with the arm at the side and elbow flexed to 90°: O = 65, U = 69. Strength measured with a dynamometer in pounds of force for the operated (O) and uninjured (U) shoulder were external rotation: O = 18, U = 22; forward flexion: O = 19, U = 23; and abduction: O = 14, U = 16. 49 of 60 patients returned to their preinjury work and activities. Nine patients were unable to return to work/activities due to reasons unrelated to their scapula fracture (ie, brachial plexus injury, spinal cord injury). Complications included three patients with shoulder stiffness requiring manipulation under anesthesia postoperatively, exchange of intra-articular screws in two patients immediately postoperative, removal of clavicle hardware in two patients and scapula hardware in one patient, and repeat open reduction and internal fixation of a clavicle nonunion.

Conclusion: Our data suggest surgery for extra-articular fractures of the scapula is associated with good functional results and a low complication rate.


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.