Complication Risks Following Open Reduction Internal Fixation Versus Nonsurgical Treatment of Scapular Fractures

Scapula fractures vary considerably in type, location, and management. Surgical management is commonly through open reduction internal fixation (ORIF), but the existing literature on its clinical outcomes is inconsistent compared with conservative management. This descriptive study reports the risk of short- and long-term complications from ORIF and nonsurgical treatment of various scapula fracture subtypes.

Retrospective analysis of the TriNetX database was performed. Twelve cohorts were created, with two for each treatment modality for every fracture location investigated, including glenoid cavity, scapula body, neck, coracoid, acromion, and all fractures combined. Patients treated with surgery other than ORIF were excluded. Demographics and comorbidity prevalence were identified. Orthopaedic and medical complications were measured at 90 days, 1 year, and 5 years.

Glenoid and scapular body fracture patients were the most and least treated with ORIF, respectively. In the ORIF cohorts, coracoid fracture patients saw risk for shoulder dislocation (3.6%) and brachial plexus injuries (3.0%) at 3 months, whereas acromion fracture patients had risk of malunion/nonunion (4.6%), ORIF revision (6.2%), and shoulder osteoarthritis (10.3%) 5 years after surgery. In the nonsurgical cohorts, glenoid fracture patients were at risk for shoulder stiffness, osteoarthritis, and arthroplasty at all time intervals.

Coracoid and acromion fracture patients following ORIF, and glenoid fracture patients following nonsurgical treatment, were at risk for several mechanical complications. Such patients should be thoroughly counseled by their surgeons on these risks, and closely monitored following injury to ensure that adverse outcomes may be caught early and addressed to preserve their shoulder function.