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Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
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Radiographic Risk Factors for Scapular Stress Fractures After Reverse Total Shoulder Arthroplasty: A Case-Control
Joseph J Bengart1, Kevin T Kohut, Mohammad N Haider
1From the Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY (Bengart, Haider, and Duquin), the UBMD Orthopaedics and Sports Medicine, Buffalo, NY (Feng), and the Oregon Shoulder Institute, Medford, OR (Kohut).
The Journal of the American Academy of Orthopaedic Surgeons
|March 13, 2026
Summary
Acromial fractures after reverse total shoulder arthroplasty (rTSA) are linked to specific radiographic factors. Surgeons can mitigate risk by monitoring the acromion to lateral humerus distance and glenoid fixation.
Area of Science:
- Orthopedic surgery
- Radiology
- Biomechanical analysis
Background:
- Acromial and scapular spine fractures complicate reverse total shoulder arthroplasty (rTSA), with reported rates from 0.8% to 7.2%.
- Identifying preoperative and postoperative radiographic risk factors is crucial for preventing these fractures.
Purpose of the Study:
- To identify radiographic risk factors for scapular stress fractures after primary rTSA.
- To provide surgeons with quantifiable recommendations to reduce fracture risk.
Main Methods:
- Retrospective case-control study of patients undergoing rTSA from 2010-2021.
- Patients with stress fractures were matched 3:1 with a control group.
- Radiographic analysis at multiple time points compared fracture and control groups.
Main Results:
- Lower preoperative Hamada classification (1-3 vs. 4-5) and wider postoperative acromion-lateral humerus distance were associated with fractures.
- The fracture group showed an increase in acromion-lateral humerus distance (2.3 mm), while controls had a reduction (3 mm).
- Acromion-lateral humerus distance and Hamada classification predicted fractures with 80.4% accuracy; a cutoff of 9.78 mm was identified.
Conclusions:
- The acromion-lateral humerus distance is a valuable tool for assessing acromial fracture risk.
- Recommendations include avoiding a distance >10 mm and using unicortical glenoid screw fixation to prevent stress risers.
