Clinical Orthopaedics and Related Research®
Volume 469, Number 9, 2544-2549, DOI: 10.1007/s11999-011-1881-3

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The Association of Bone and Joint Surgeons®

Symposium: Reverse Total Shoulder Arthroplasty

Scapula Fractures After Reverse Total Shoulder Arthroplasty: Classification and Treatment

Lynn A. Crosby, Adam Hamilton and Todd Twiss

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Abstract

Background  

Reverse total shoulder arthroplasty (RTSA) implants have been developed to treat patients with deficient rotator cuffs. The nature of this procedure’s complications and how these complications should be managed continues to evolve. Fractures of the scapula after RTSA have been described, but the incidence and best methods of treatment are unclear.

Questions/purposes  

We therefore (1) determined the incidence and (2) developed a classification system intended to suggest the best choice of treatment.

Patients and Methods  

We reviewed the records of 400 patients treated with RTSA over 4.5 years and identified all patients with scapula fractures. We identified three discrete patterns: avulsion fractures of the anterior acromion (Type I); fractures of the acromion posterior to the acromioclavicular joint (Type II); and fractures of the scapular spine (Type III).

Results  

Twenty-two patients (5.5%) had fractures. Eight (2.0%) had Type I fractures on the first followup radiographs; these patients were treated nonoperatively with resolution of symptoms. Ten (2.5%) had Type II fractures a mean of 10.8 months after RTSA; seven of the 10 were treated surgically with improvement in their clinical symptoms. Four (1%) had Type III fractures at a mean of 10.3 months; all four fractures were treated with surgical fixation with healing.

Conclusions  

Scapula fracture is a relatively common complication of RTSA. Our observations suggest Type I fractures can be observed with a likelihood of symptom relief. For Type II fractures, we recommend acromioclavicular joint resection if stable but open reduction internal fixation if unstable. We believe Type III fractures are best treated with open reduction internal fixation.

Level of Evidence  

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
One of the authors (LAC) has received royalties and consulting fees from Exactech (Gainesville, FL) for a product related to this study.
Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at Wright State University Boonshoft School of Medicine, Dayton, OH, USA, and the Medical College of Georgia, Augusta, GA, USA.

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