Mesh Plates for Scapula Fixation

Phadnis, Joideep; Clitherow, Harry D.S.; Bain, Gregory I.

doi:10.1097/bte.0000000000000054

Cited by 14 publications

(15 citation statements)

References 20 publications

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“…The onset of pain occurs, on average, 2 months to 48 months postoperatively. 10,12,16,18,19,33 However, Teusink et al 14 reported a patient with scapular spine fracture 8 years postoperatively. The physiotherapist may report that the patient is progressing slowly with rehabilitation or has deteriorated.…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…However, the technical challenges of rTSA have resulted in a reported complication rate of 19% to 68%, 3,4,7 with the most common complications including scapular notching, glenoid component loosening/ failure, infection and instability. 2,8 Stress fractures of the shoulder girdle involving the acromion, [9][10][11][12][13][14][15] scapular spine, [16][17][18][19][20][21] clavicle, 22 and coracoid 23 after rTSA are less frequent complications and consequently, they have received limited focus within the upper extremity literature. The more common subset of the aforementioned stress fractures occurs in the acromion and scapular spine in 3.1% to 10% [9][10][11][12][13][14][15]18,19,21 of patients undergoing rTSA and comprises the primary focus of the present review.…”

Section: Introductionmentioning

confidence: 99%

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Acromial and scapular spine fractures after reverse total shoulder arthroplasty

et al. 2016

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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.

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Section: Clinical Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acromial and scapular spine fractures after reverse total shoulder arthroplasty

et al. 2016

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“…Non-displaced fractures detected early can be treated conservatively, but the management of displaced fractures is challenging for the surgeon because of high rates of malunion or nonunion; also, decreased functional acromial fractures after RSA are challenging to treat because of the complex 3-dimensional anatomy, poor bone stock, and variation in fracture patterns, each of which makes stable fixation difficult. 8) When open reduction and internal fixation is the preferred mode for treating displaced lateral acromion fractures, the goal is to apply compression at the fracture site and neutralize the distraction forces of the deltoid. 7) To obtain adequate fixation, several techniques (tension bands, mesh plates, cruciform pilon plates, and locking plates) have been introduced.…”

Section: Discussionmentioning

confidence: 99%

“…7) To obtain adequate fixation, several techniques (tension bands, mesh plates, cruciform pilon plates, and locking plates) have been introduced. [6][7][8][9][10] The previously described tension band-fixation technique resulted in poor functional results for postoperative acromial fractures. 6,7) This fixation method may be insufficient to withstand the forces generated by the deltoid muscle.…”

Section: Discussionmentioning

confidence: 99%

Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Cho

Jung

Lim

et al. 2019

Clin Shoulder Elbow

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Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

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“…For this reason, ORIF is more heavily considered with improved clinical outcomes following rigid plate fixation compared with tension band fixation [5•, 50, 51]. Camarada et al and Rouleau et al demonstrated fracture union and good clinical outcomes with the use of a mesh plate and perpendicular 90/90 small fragment locking plate configurations for operative treatment of displaced scapular spine fractures [53,54]. Despite these promising results, this classification system has been shown to have mixed inter-observer reliability [5•, 52, 55].…”

Section: Loss Of Compression: Subscapularis Deficiencymentioning

confidence: 99%

Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

Markes

Cheung

Benjamin

2020

Curr Rev Musculoskelet Med

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Purpose of Review The most common complications warranting revision consideration in reverse shoulder arthroplasty (RSA) include instability and its associated causes: infection, periprosthetic fracture, and glenoid baseplate loosening. Management of complications can be challenging and the nuances of treatment are still being elucidated. The focus of this paper is to review the treatment of the failed RSA and discuss evidence-based recommendations for revision. Recent Findings The most common complications requiring revision RSA are instability and infection. The causes for instability can be subdivided into three main subcategories: loss of compression, loss of containment, and impingement. Loss of compression is further broken down into 6 subcategories revolving around abnormal prosthesis positioning, undersized prostheses, or intrinsic soft-tissue tension loss leading to instability. Periprosthetic infection can also lead to instability, yet the most appropriate management for infected RSA remains controversial. Summary Restoring stability by maximizing deltoid and soft tissue tension while avoiding impingement revolves around three basic methods: (1) lateralizing and/or upsizing the glenosphere to an inferior position on the glenoid, (2) use of a more constrained polyethylene insert, and (3) distalizing the humerus by increasing the polyethylene thickness and/or the thickness of the humeral tray. Management of periprosthetic joint infection can be performed in one-stage, two-stage, or "three-stage" procedures all showing good outcomes with two-stage procedures being the most commonly performed. However, persistent positive culture with propriobacterium acnes can occur in up to 25% of cases. In order to limit the associated morbidity from failed revision reverse shoulder arthroplasty, continued research on best management of associated complications is warranted.

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Mesh Plates for Scapula Fixation

Cited by 14 publications

References 20 publications

Acromial and scapular spine fractures after reverse total shoulder arthroplasty

Acromial and scapular spine fractures after reverse total shoulder arthroplasty

Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

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