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Beitragstitel ORIF of scapular spine fractures after reverse total shoulder arthroplasty with a double plating technique
Beitragscode P013
Autoren
  1. Felix Toft Schulthess Klinik Vortragender
  2. Tomas Drobny Schulthess Klinik Zürich
Präsentationsform Poster
Themengebiete
  • A1 - Schulter/Ellbogen
Abstract Background
Scapular spine fractures after reverse total shoulder arthroplasty (RTSA) are a severe complication,
compromising patient satisfaction and shoulder function, sometimes even leading to instability of the
shoulder prosthesis with resulting joint dislocation. Conservative management
has been the dominant treatment choice in the past. The purpose of this study was to describe our
experiences with surgical management of these fractures in 5 Patients, including surgical approach,
implant choice for internal fixation and rationale behind fixation method, and to present the early
clinical outcome.
Methods
From September 2015 on, patients with above mentioned fractures were informed about conservative as
well as surgical treatment options and the inherent risks and chances of either choice. Patients were
only treated with ORIF after elaborate informing about the pros and cons of ORIF and our previous
unsatisfactory experiences with this complication under conservative management, and patients consent
(informed consent). All 5 patients agreed to undergo surgery.
Results
All patients were female with a mean age of 76 years (range 73-81,±3.3 years). Four of the five (80%)
treated patients had osteoporosis confirmed by DEXA, the fifth had Vit. D substituion due to a
suspected osteopenia/-porosis. Four out of five (80%) patients had a diagnosed depression with
antidepressive medication. Mean time from RTSA surgery to fracture occurance was 60 months (range
4 – 113, ±45.2 months). Mean time from fracture occurance to surgical treatment was 17.2 weeks
(range 1-52,± 21.2 weeks). A bicortical iliac crest bone graft with additional cancellous bone grafting
was used in 2 patients (nonunions), cancellous bone grafting alone in further 2 patients (delayed unions)
and 1 patient was treated with ORIF alone (acute fracture). All surgically treated scapular spine
fractures healed (100%). Two patients had one complication (iatrogenic pneumothorax, screw
loosening) with only the pneumothorax requiring further treatment (chest tube insertion). Patient
satisfaction and shoulder function increased, pain levels decreased (Constant/ASES/quickDASH) at 12
months post surgery compared to preoperative values.
Conclusions
ORIF for scapular spine fractures after RTSA with the surgical technique presented seems to achieve
reproducible good results with bony union and improved outcome scores despite osteopenic/-orotic
bone quality.