Cuff Arthropathy, Scapular Spine Fracture Non-union, and Instability: Open Reduction, Internal Fixation &...

This article presents a simultaneous operative technique, which allowed to successfully treat a Cuff Tear Arthropathy (CTA), instability and Levy-type III scapular spine fracture non-union with 90°-double plating, humerus-to-scapula grafting and simultaneous reverse shoulder arthroplasty.

We present a 64year-old woman with previously known cuff arthropathy (2012/53yo). She fell in 2017 (58 years old with minor shoulder disability) before dislocating the shoulder in 2020 (60 years old) with evidence of a medial Levy-type III scapular spine fracture non-union and severe apprehension, unable to anterior elevate her arm more than 90°. She underwent ORIF of a flexed scapular spine with locked 90°-double plating and bone grafting as well as simultaneous lateralized reverse shoulder arthroplasty (RSA) with an excellent outcome at 3.5 years of follow-up (Constant score of 84 points and a subjective shoulder value of 99%).

The radiographic sequence suggests an abduction fracture mechanism due to an axial force. RSA with simultaneous locked 90°-double plating with grafting from the humeral head achieved correction and union with an outstanding result despite tensioning the deltoid with a lateralized RSA. To deal with excessive forces, five important practical recommendations are essential: (1) assess the bone stock with a CT-scan, (2) span the scapular spine and acromion with a long superior plate and its screws, (3) use at least two locking screws on either side of the fracture on each plate, (4) avoid stress risers from erroneous drilling, and (5) protection with an abduction sling for 6-8 weeks.