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Could the Scapular Spike Sign Be Used as a Radiographic Proxy for Surgical Indications?

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The scapular spike sign is a reliable radiographic indicator for surgical intervention in displaced scapula fractures. This easily identifiable sign helps surgeons efficiently manage complex fractures, improving patient outcomes.

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Area of Science:

  • Orthopaedic Surgery
  • Radiographic Diagnostics
  • Trauma Care

Background:

  • Scapula fractures are rare, often underdiagnosed, and present treatment variability.
  • Displaced scapula fractures can lead to long-term patient detriment.
  • Improved understanding of surgical indications is needed for efficient patient management.

Purpose of the Study:

  • Evaluate the 'spike sign' (lateral border displacement) as a marker for surgical indications in displaced extraarticular scapular fractures.
  • Determine the diagnostic performance (sensitivity, specificity, PPV, NPV) of the spike sign threshold for surgery.
  • Assess the interobserver and intraobserver reliability of the spike sign.

Main Methods:

  • Retrospective diagnostic study of 268 patients with AO/OTA 14B extraarticular scapular fractures.
  • Radiographic assessment of the 'spike sign' against established surgical criteria (offset ≥ 2 cm, angulation ≥ 45°, GPA ≤ 22°, or double disruption).
  • Two orthopaedic trauma fellows assessed interobserver and intraobserver reliability.

Main Results:

  • A spike sign threshold of ≥ 0 cm demonstrated 100% positive predictive value for surgery.
  • Sensitivity was 28% and specificity was 100% for the spike sign indicating surgery.
  • The spike sign showed excellent interobserver (κ=0.84-0.88) and intraobserver (93.75-100%) reliability.

Conclusions:

  • The scapular spike sign is an easily identifiable and reliable radiographic finding for extraarticular scapula fractures.
  • A positive spike sign can serve as a proxy for surgical indications, enabling efficient management.
  • Further research should explore the spike sign's utility in trauma settings and its impact on surgical rates.