FRACTURES OF THE SCAPULA: RETROSPECTIVE ANALYSIS OF 27 CASES

Abstract

Purpose of the study: Orthopedic treatment is generally proposed for minimally displaced fractures of the scapula. Surgery is indicated in the event of medialization or disorientation of the glenoid cavity. The purpose of this study was to identify rules for management of problematic cases.

Material and methods: This retrospective study included 27 patients, 22 men and five women, mean age 46.7 years (range 22–83 years). The fracture was limited to the scapula in 17 and was part of thoracic syndrome in ten. Injury to the plexus was noted in three patients. Associated lesions were noted in 55% of patients. Orthopedic treatment was proposed for 15 patients (group 1) and surgical treatment for 12 (group 2): neck osteosynthesis (n=4), clavicle fixation (n=5), combined osteosynthesis (n=3).

Results: Mean follow-up was 47.3 months; 21 patients were reviewed (four lost to follow-up, two deaths). Per primam healing was achieved for all fractures. There were no complications related to the surgical procedure in group 2 and no secondary displacement in either group. Mean time to resumed occupational activity was four months (range 0.2–25 months): 2.2 months (1–5 months) in group 1 and 5.5 months (0.2–25 months) in group 2. The age and gender weighted Constant score for the overall series was 96.2% (range 80–100%) with 81% excellent and very good functional outcomes. In group 1, the Constant score was 95.4% (81–100%) with 70% excellent and very good functional outcomes. It was 97% (80–100%) in group 2 with 91% excellent results. At last follow-up, there was only one case of Samilson grade 2 osteoarthritis.

Discussion and conclusion: The functional outcome observed after treatment of scapular fractures is satisfactory. Orthopedic treatment should be reserved for non-displaced fractures. If there is significant medial offset of the glenoid cavity or instability, osteosynthesis of the scapular neck is indicated, possibly with reinforcement by fixation of the clavicle. Isolated osteosynthesis of the clavicle stabilizes the scapular ring but does not reduce the scapular fracture.