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Updated: Mar 14, 2026

Reverse Total Shoulder Arthroplasty

Reverse Total Shoulder Arthroplasty

Published on: July 5, 2011

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

This summary is machine-generated.

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.

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Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography

Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography

Published on: March 12, 2021

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.