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Case Series Evaluating the Operative and Nonoperative Treatment of Scapular Fractures

August 31, 2018|Surgery
Peter A. Surace, MD;Alysse J. Boyd, MA;Heather A. Vallier, MD
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Dr. Surace is a Resident Physician, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. Ms. Boyd is a Researcher, Department of Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio. Dr. Vallier is a Professor of Orthoepdic Surgery, Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio.

Address correspondence to: Heather A. Vallier, MD, Case Western Reserve University, Department of Orthopaedic Surgery, 2500 MetroHealth Drive, Cleveland, OH 44109 (tel, 216-778-7476; email, hvallier@metrohealth.org).

Peter A. Surace, MD Alysse J. Boyd, MA Heather A. Vallier, MD . Case Series Evaluating the Operative and Nonoperative Treatment of Scapular Fractures. Am J Orthop.

August 31, 2018

TAKE-HOME POINTS

  • The majority of patients with scapula fractures are multiply-injured.
  • Despite being multiply-injured, most heal with minimal functional shoulder impairment.
  • While concomitant injuries do not appear to affect shoulder function scores, tobacco use and alcohol abuse are associated with worse outcomes after scapula fractures.
  • Most scapula fractures can be treated successfully without surgery.
  • Although patients had higher average function scores after open reduction and internal fixation, further research should be done to define indications for fixation.

ABSTRACT

The injury parameters and patient characteristics that affect function after scapular fracture are poorly defined. We performed a retrospective review of 594 adult patients with a minimum 12-month follow-up after scapular fracture. Functional outcomes were prospectively assessed using the American Shoulder and Elbow Surgeons (ASES) survey in 153 patients after a mean of 62 months of follow-up. The population was 78% male, and 88% had injuries caused by a high-energy event. Only 4.6% had injuries isolated to the scapula. All fractures healed primarily and the mean ASES score was 79.3, indicating minimal functional impairment. However, 7 patients (4.6%) reported severe functional deficits. Fifteen patients (9.8%) underwent open reduction and internal fixation. These patients had a better mean ASES score than those who were treated nonoperatively (92.1 vs 77.9, P = .03). When fracture types were analyzed individually, there was an advantage to surgery in fractures involving the glenoid (96.0 vs 75.7, P < .05). Concomitant chest wall injury or the presence of adjacent fractures did not affect functional outcomes. Smokers had a worse mean score (73.3 vs 84.5, P = .01), as did patients with a history of alcohol abuse (70.3 vs 83.9, P < .05). In conclusion, mean ASES scores indicated good function overall. Patients with a history of tobacco use or alcohol abuse had worse outcome scores.

Continue to: Scapular fractures occur frequently due to high-energy trauma...

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