Locked 90°-double plating of scapular spine fracture after reverse shoulder arthroplasty with union and good outcome despite plate adjacent acromion fracture

Abstract

We report the case of a 74-year-old woman who sustained a scapular spine (SS) fracture after a fall 4 weeks after reverse shoulder arthroplasty (RSA). Open reduction and internal fixation (ORIF) with locked 90°-double plating resulted in union of the SS fracture with a good outcome (subjective shoulder value: 80%; Constant score 67; 1 year) despite of an adjacent lateral acromion fracture 3 weeks after ORIF. This is the second description in the literature of a successful double plate ORIF with union of an SS fracture after RSA. SS fractures are known to lead to poor RSA outcomes with a high mal-union rate and non-union rate. We describe the positioning of the plates and technical steps for successful ORIF to avoid complications, discuss the aftercare and report the outcome.

Treatment strategies for scapular spine fractures: a scoping review

“…Likewise Bauer et al chose fracture fixation in a double plate technique. 28 At the final follow-up the patient was pain free and had only slight discomfort. Debeer et al presented a patient who underwent open reduction and internal fixation (ORIF) with a single plate.…”

“…Three studies with seven patients reported operative treatment. 26 – 28 Toft et al reported a case series of five patients treated with two plates in 90/90° configuration. The patients achieved a higher Constant–Murley Score (CMS) compared to the situation before the RSA implantation, but three of four patients did not reach the same mobility level as before the fall (for one patient the information was not available).…”

“…The patient was satisfied and achieved good functional results. 28 In the third study, Groot et al presented a case report with a patient who was treated with plate fixation. After the follow-up the patient was pain free and reached the same mobility level as before the fall.…”

“…Only three studies with seven patients reported operative treatment for elderly patients with a fracture after RSA implantation. 26 – 28 Toft et al fixed the fracture using a double plate technique. 27 The range of motion improved after fracture fixation but did not reach the level before the fracture.…”

Acromial and Scapular Spine Fractures following Reverse Total Shoulder Arthroplasty—A Systematic Review of Fixation Constructs and Techniques

“…One study was identified from review references of the identified articles [ 29 ]. In total, nine clinical studies with 18 acromion or scapular spine fractures met the inclusion and exclusion criteria and were included in this review [ 16 , 17 , 18 , 29 , 30 , 31 , 32 , 33 , 34 ]. A detailed flow diagram of the search results is provided under Figure 2 .…”