Scapular fractures. Analysis of 113 cases

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Musculoskeletal Research

Background:

• Scapular fractures, particularly of the neck and spine, have been historically understudied with limited long-term follow-up.
• Previous research lacks comprehensive data on the functional outcomes and disability associated with displaced scapular fractures.

Purpose of the Study:

• To report the largest series of scapular fractures to date, including a significant long-term follow-up evaluation.
• To assess the functional disability associated with displaced scapular neck and spine fractures.
• To evaluate the efficacy of operative management for these specific fracture types.

Main Methods:

• A retrospective review of 148 scapular fractures in 116 scapulae (113 patients) was conducted.
• A subgroup of 24 patients underwent long-term follow-up evaluation.
• Operative management involved extensile exposure via a posterior Judet incision, rigid internal fixation, and early motion protocols.

Main Results:

• Significant disability was observed in patients with displaced scapular spine and neck fractures, including rest pain (50%-100%), exertional weakness (40%-60%), and exertional pain (20%-66%).
• Excellent outcomes were achieved in eight surgically treated cases, with patients regaining at least 85 degrees of glenohumeral abduction and normal scapulothoracic motion.
• Post-operative assessments showed no resting pain, night pain, or pain with abduction in the surgically treated group, with a minimum follow-up of 15 months.

Conclusions:

• Displaced scapular neck and spine fractures are associated with substantial functional impairment.
• Indications for surgical intervention should be broadened to encompass displaced scapular neck and spine fractures.
• Operative management using extensile posterior Judet approach, rigid fixation, and early motion yields excellent functional recovery and pain relief.