Treatment strategies for scapular spine fractures: a scoping review

Abstract

Fractures of the scapular spine are relatively rare and can occur without (1) or with (2) association to a reverse shoulder arthroplasty (RSA). To date there are only limited data on the topic. The aim of this scoping review was to identify all available literature and report current treatment concepts. A scoping review was conducted by searching PubMed for relevant studies between 2000 and October 2020. All studies were included which gave detailed descriptions of the treatment strategy. A total of 21 studies with 81 patients were included for the analysis. The mean age over all patients was 62 years (range: 24 to 89 years) and 77% of the patients were female. In 19.8% of cases, the fracture occurred after a traumatic fall from standing height. Eighty-six per cent of the patients had an RSA-associated scapular spine fracture (2). These patients were older compared to group (1) (47 ± 19.6 vs. 76 ± 5.6 years, p = 0.0001) and the majority were female (85%). The majority from group (1) underwent operative treatment with plate fixation. Most patients regained full function and range of motion. RSA-associated fractures (2) were mainly treated non-operatively, with moderate clinical outcome. A high rate of nonunions was reported. Scapular spine fractures without RSA are mainly treated operatively with good clinical results. In association with RSA, scapular spine fractures are mainly treated non-operatively and lead to inferior clinical and radiological results. This scenario seems to be problematic and further research is required to sharpen treatment concepts in this group. Cite this article: EFORT Open Rev 2021;6:788-796. DOI: 10.1302/2058-5241.6.200153

Scapular spine fracture, presentation of two cases and novel surgical treatment

“…Cassidy 3 did not report the type of implant been used among their pooled data of SSF. Sußiek 17 reported pooled result of 11 studies reporting SSF after RSA; among the 50 cases, 2 did not report the type of implant, 21 used Grammont style RSA (mainly Delta III, Depuy Synthes, Raynham, MA, USA), and 27 lateralized implants (mainly Ascend flex; Tornier, Bloomington, MN, USA following by DJO surgical, Lewisville, TX, USA).…”

“…In Sußiek 17 review, they identified 11 studies including 69 patients who had spine of scapular fracture with RSA. Nearly all of those 62 patients treated nonoperatively were limited with their shoulder function at the final follow-up and only 6 of them had bony union (although many did not have reported radiographic follow-up, so the number probably underrated).…”

“…SSF will deteriorate RSA functional score and pain level. 17 This is challenging as even surgical fixation will not necessarily restore previous function. 15 …”

Nonunion of the so-called acromion: a systematic review with consideration of the terminology

“…Of these 11 patients, only two had multiple disruptions of the SSSC, which would have required early surgical treatment if the circumstances allowed [ 40 , 47 ]. As the potential complications of nonoperative management include painful fracture nonunion or increasing fragment displacement [ 40 , 86 – 88 ], periodic imaging observations are required during conservative treatment until the bone union is achieved. However, although displacement is the indication for surgery in patients with apophyseal fractures, most authors did not specify the degree of displacement [ 89 ].…”

Arthroscopic Excision for Painful Acromial Fracture Nonunion After Reverse Total Shoulder Replacement

“…Operative treatment of the acromion has been described, most commonly involving open reduction and internal fixation of postoperative fractures. 4 However, achieving fixation is difficult in the setting of small fragments and is associated with the risk of complications, as well as the potential need for subsequent hardware removal. Thus, an alternate consideration for small fractures may be excision alone.…”