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

Abstract

Background Scapular fractures are uncommon injuries of upper extremity resulting mostly from high-energy trauma. Extraarticular 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. Methods 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 3.5 mm 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. ResultsThe patients included 10 males and two females. Mean age was 42 years. Average follow-up was 33 months. 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. Conclusion Displaced extra-articular scapular fractures managed by internal fixation using T buttress locking plates and reconstruction plates give good functional outcome.

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

“…In the past, most scholars have recommended conservative treatment for such fractures, but with medical advances and improved understanding of the anatomy and biomechanics of the scapular neck, orthopedic surgeons who treat SNFs agree that surgical rather than conservative treatment of unstable scapular fractures improves patient outcomes [ 3 , 11 , 12 , 19 , 20 ]. Open reduction and internal fixation in the treatment of SNFs are beneficial to early postoperative functional exercise, reduce pain, and prevent complications such as malunion, muscle imbalance, rotator cuff dysfunction, scapulothoracic dyskinesis and impingement [ 9 , 20 , 21 ]. However, owing to the complex anatomical structure of the scapula neck, a standard internal fixation device is lacking in clinical practice.…”

“…Jaikish et al [ 9 ] achieved good clinical results in the treatment of displaced SNFs using reconstructive plates. They believed that RP for SNFs can ensure solid fixation and enable early functional exercise of the shoulder.…”

“…Currently, many surgical implant schemes can be used to treat SNFs, including reconstruction plates (RPs), straight locking plates, distal radius T-plates, and Y-locking plates [ 4 , 8 – 10 ]. RPs are the most commonly used as they provide relatively reliable internal fixation and general functional results [ 3 , 9 , 11 ]. However, RP does not conform to the anatomic shape of the scapular neck, and the strength of RP is also affected by the need for repeated adjustments.…”

Operative Fixation of Extra-articular Scapula Body Fracture Through a Modified Judet Approach

“…Scapular fractures are uncommon fractures of the upper extremity, constituting only 0.4%–1% of all fractures and 3%–5% of shoulder fractures. 1 Although most scapular fractures are nondisplaced or minimally displaced and can be managed nonoperatively with good clinical outcomes, certain displaced fractures may require surgical fixation.…”

“…Operative fixation of scapula fractures is complex not only because of the approach and fixation technique, but also because of difficulty obtaining proper reduction and intraoperative radiographs. 1 In addition, there is risk of neurovascular injury during internal fixation. In this case, a modified Judet approach was used to expose the scapular fracture, and a series of mini fragment plates are used for fracture fixation.…”