Scapular Alignment Restoration After Posterior Fixation of Displaced Scapular Fractures

Background and Objectives: The surgical management of displaced scapular fractures remains controversial, particularly regarding the importance of restoring scapular alignment. This study evaluated radiologic restoration and clinical outcomes following posterior fixation of displaced scapular fractures, with a particular focus on correction of lateral border offset (LBO) and angular deformity. Materials and Methods: This retrospective case series included 20 patients who underwent posterior open reduction and internal fixation for displaced scapular fractures between 2017 and 2024 with a minimum follow-up of 12 months. Surgical indications included lateral border offset (LBO) > 20 mm, angular deformity > 30°, or displaced intra-articular fractures with step-off > 3 mm. Radiologic parameters including LBO, angular deformity, and intra-articular step-off were measured using computed tomography before and after surgery. Clinical outcomes were evaluated using shoulder range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (DASH) score, and modified American Shoulder and Elbow Surgeons (ASES) score. Results: Significant postoperative improvement was observed in all radiologic parameters. Mean LBO improved from 18.9 ± 10.7 mm (range, 0-45.5 mm) to 3.1 ± 7.1 mm (range, 0-29.9 mm), angular deformity improved from 28.7° ± 11.3° (range, 10.2-48.1°) to 0.9° ± 3.9° (range, 0-17.8°), and intra-articular step-off improved from 6.4 ± 2.0 mm (range, 3.7-9.7 mm) to 1.8 ± 0.5 mm (range, 1-2.5 mm). At final follow-up, mean forward flexion was 126° ± 34.4° (range, 10-170°) and external rotation was 62.3° ± 20.8° (range, 0-90°). Mean DASH and modified ASES scores were 27.3 ± 17.3 (range, 8.3-74.2) and 71.6 ± 15.0 (range, 25.8-89), respectively. Glenoid involvement was not associated with inferior clinical outcomes, whereas associated ipsilateral upper extremity injuries tended to be related to poorer functional results. Conclusions: Posterior fixation effectively restored scapular alignment and articular congruity in displaced scapular fractures. Restoration of LBO and correction of angular deformity may represent important surgical objectives for correction of glenoid medialization and restoration of normal scapular alignment.