Abstract:We report an 89-year-old woman with bilateral atraumatic scapular spine fracture several months after bilateral reverse total shoulder arthroplasty (RTSA). Recently, RTSA has gained popularity in the surgical treatment of complex shoulder disorders such as cuff tear arthropathy. However, scapular fractures may occur several months after surgery as a late complication of this procedure. In this case report we focus on a relatively uncommon subtype, the scapular spine fracture. Although well-known in the orthope… Show more
“…34 The radiation exposure is 80% to 85% less than a standard CT Scan. 35 Nicolay et al 36 described the use of SPECT/CT in a patient with bilateral atraumatic scapular spine fractures after rTSA in the radiological literature.…”
Section: Imagingmentioning
confidence: 99%
“…35 Nicolay et al. 36 described the use of SPECT/CT in a patient with bilateral atraumatic scapular spine fractures after rTSA in the radiological literature. Figure 2.A 77-year-old patient 4 months after reverse total shoulder arthroplasty.…”
Acromial and scapular spine fractures after reverse total shoulder arthroplasty occur predominantly as a result of bony insufficiency secondary to patient and intra-operative technical factors. The spectrum of the pathology can range from a stress reaction to an undisplaced or displaced fracture. Prompt diagnosis of these fractures requires a high suspicion in the postoperative patient with a clinical presentation of acute onset of pain along the acromion or scapular spine and/or deterioration of shoulder function. Conventional shoulder radiographs are frequently unreliable in identifying these fractures, especially if they are undisplaced. Computed tomography (CT) and/or single photon emission computed tomography/CT scans are useful imaging modalities for obtaining a definitive diagnosis. Early diagnosis and non-operative treatment of a stress reaction or undisplaced fracture is essential for preventing further displacement and potential disability. The management of displaced fractures is challenging for the orthopaedic surgeon as a result of high rates of mal-union or non-union, decreased functional outcomes, and variable results after open reduction and internal fixation. Strategies for preventing these fractures include optimizing the patient's bone health, correct glenoid baseplate screw length and position, and avoiding excessive deltoid tension. Further research is required to identify the specific patient and fracture characteristics that will benefit from conservative versus operative management.
“…34 The radiation exposure is 80% to 85% less than a standard CT Scan. 35 Nicolay et al 36 described the use of SPECT/CT in a patient with bilateral atraumatic scapular spine fractures after rTSA in the radiological literature.…”
Section: Imagingmentioning
confidence: 99%
“…35 Nicolay et al. 36 described the use of SPECT/CT in a patient with bilateral atraumatic scapular spine fractures after rTSA in the radiological literature. Figure 2.A 77-year-old patient 4 months after reverse total shoulder arthroplasty.…”
Acromial and scapular spine fractures after reverse total shoulder arthroplasty occur predominantly as a result of bony insufficiency secondary to patient and intra-operative technical factors. The spectrum of the pathology can range from a stress reaction to an undisplaced or displaced fracture. Prompt diagnosis of these fractures requires a high suspicion in the postoperative patient with a clinical presentation of acute onset of pain along the acromion or scapular spine and/or deterioration of shoulder function. Conventional shoulder radiographs are frequently unreliable in identifying these fractures, especially if they are undisplaced. Computed tomography (CT) and/or single photon emission computed tomography/CT scans are useful imaging modalities for obtaining a definitive diagnosis. Early diagnosis and non-operative treatment of a stress reaction or undisplaced fracture is essential for preventing further displacement and potential disability. The management of displaced fractures is challenging for the orthopaedic surgeon as a result of high rates of mal-union or non-union, decreased functional outcomes, and variable results after open reduction and internal fixation. Strategies for preventing these fractures include optimizing the patient's bone health, correct glenoid baseplate screw length and position, and avoiding excessive deltoid tension. Further research is required to identify the specific patient and fracture characteristics that will benefit from conservative versus operative management.
“…A number of complications relating to SS are a result of a lack of knowledge of its anatomically morphological features. A single traumatic event and the tip of the metaglene screw are more likely to be the reason of SS fractures, which result in an increased risk of revision and dislocation and inferior clinical outcomes [4,13,18]. Acute pain can also occur without trauma, and the most common etiology during the initial postoperative years is a fracture of the SS [4,7,9,19,20].…”
BackgroundThe occurrence of fractures and risks following reverse total shoulder arthroplasty (rTSA) is common due to the variation of scapular spine (SS). Therefore, the consideration of the variable osteological features of SS prior to surgery may prove to be significant for the implementation of rTSA. This study aimed to propose a classification of SS through particular and quantitative parameters.Material/MethodsIn total, 354 intact dry scapulae were geometrical measured and classified on account of anatomical characteristics and the shapes of SS.ResultsType I SS was found, and this was the most frequency was type (27.97%). The least common type was type II. The type of SS had a direct association with bone stock and bone mineral density. Type II represented an association with a much thinner spine and restricted cortical and cancellous bone; types II and V were also associated with a crooked SS, which had a more complex morphology.ConclusionsThis study offered a comprehensive classification of SS in the Chinese population. On the whole, this study indicates that knowledge of the morphological variations of SS can prompt the diagnosis of scapular fractures and can promote more successful rTSA procedures, and the relative clinical trial is necessary to support it.
“… 1 – 11 SS fractures are likely to propagate from a single traumatic event and often find their origin at the tip of the metaglene screw, leading to inferior clinical outcomes and an increased risk of revision and dislocation. 4 , 5 , 12 , 13 In addition, the SS has been demonstrated to be the most useful region for screw fixation for reverse total shoulder arthroplasty prosthesis on account of more bone stock and cortical thickness which increase screw pullout strength. 14 – 16 However, there exists a significant variability in SS morphology, and knowledge of shape and dimension is critically important for these procedures.…”
Incidence of scapular spine (SS) fractures as a result of complications of reverse total shoulder arthroplasty is relatively high leading to inferior clinical outcomes and an increased risk of revision and dislocation. Fractures of SS because of trauma, including the acromion, constitute 6% to 23% of scapula fractures. The purpose of this study was to classify the SS and present specific geometrical parameters according to osteologic features. A total of 319 intact dry scapulae were collected and classified based on morphological characteristics and shape of the SS. Nine bony landmarks were also chosen and described for their relevance to regions of interest for scapular fixation. Five specific types of SS were noted and the most prevalent groups were Type 1 (Fusiform shape) (47.17%) and Type 5 (Horizontal S-shape) (19.18%). Overall, Types 3, 4, and 1 showed thicker landmark values compared to Type 5, with Type 2 having smaller values. Our classification into 5 distinct types allowed appreciation of the anatomical variance of SSs. The contours of Types 5 and 1 presented a more complex morphology and may lead to a worse surgical approach due to a fracture. As Types 2 and 5 were much thinner than the other types, these may be more susceptible to fractures.
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