Displaced scapular fractures: indication and long-term results of open reduction and internal fixation

Abstract

Displaced scapular fractures are often found in polytraumatized patients. In emergency treatment they assume a minor role. Advances in dealing with severely injured patients in most instances allow us to perform an operation on the fractured scapula within the first 2 weeks after injury. A differentiated approach is necessary as exclusively conservative treatment does not always bring about good results. From 1981–1991 we performed open reduction and internal fixation (ORIF) in 25 patients with displaced fractures of the scapula. The long-term results could be assessed in 20 patients after an average of 6.1 years. The different types of fractures were classified according to Habermeyer/Ideberg, and the Constant score was used in the evaluation of results. Some 64% of patients were involved in road accidents, and 64% suffered concomitant injuries. Articular fractures (n = 6) were the most common ones, followed by fractures of the coracoid process (n = 5) and the neck of the scapula (n = 2). There was no early postoperative complication, and follow-up showed a breakage of K-wires in one patient (fracture of the acromion). Thirteen patients obtained a very good, two patients a good, four a fair and one a poor result (according to the Constant score). Fractures of the scapular neck had the best results in terms of pain, daily activity, range of motion, and strength) as compared with fractures of the glenoid and apophyseal fractures. The radiological evaluation of the articular fractures showed advanced arthrosis of the glenoid with a discrepancy of the surface of more than 2 mm in one patient and a moderate arthrosis (first degree) with an intra-articular displacement of less than 2 mm in another one. The remaining four patients were free of articular incongruencies and other signs of arthrosis. In this retrospective study of operativley treated patients with displaced scapular fractures, more than 70% achieved very good or good results. In severely injured patients, the diagnosis of scapular fractures should be carefully excluded. Timely detection by radiography and computed tomography is mandatory for judicious decision-making concerning conservative and operative treatment.