Scapula fracture incidence in reverse total shoulder arthroplasty using screws above or below metaglene central cage: clinical and biomechanical outcomes

Kennon, Justin C.; Lu, Caroline; McGee‐Lawrence, Meghan E.; Crosby, Lynn A.

doi:10.1016/j.jse.2016.10.018

Cited by 63 publications

(58 citation statements)

References 11 publications

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“…Scapular fractures are a well-recognized complication of RTSA, and they have been reported in 0.8% to 7.2% of cases. 121 Postulated causes include excessive tensioning of the deltoid, 90 placement of a superior screw in the baseplate 122 and stress of the implants on osteoporotic bone. 123 Insufficiency fractures of the acromion or displacement of the os acromiale after RTSA can be painful and can limit ROM.…”

Section: Complicationsmentioning

confidence: 99%

Reverse total shoulder arthroplasty

Familiari¹,

et al. 2018

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Since the introduction of reverse total shoulder arthroplasty (RTSA) in 1987 (in Europe) and 2004 (in the United States), the number of RTSAs performed annually has increased.Although the main indication for RTSA has been rotator cuff tears, indications have expanded to include several shoulder conditions, many of which involve dysfunction of the rotator cuff.RTSA complications have been reported to affect 19% to 68% of patients and include acromial fracture, haematoma, infection, instability, mechanical baseplate failure, neurological injury, periprosthetic fracture and scapular notching.Current controversies in RTSA include optimal baseplate positioning, humeral neck-shaft angle (135° versus 155°), glenosphere placement (medial, lateral or bony increased offset RTSA) and subscapularis repair.Improvements in prosthesis design, surgeon experience and clinical results will need to occur to optimize this treatment for many shoulder conditions.Cite this article: EFORT Open Rev 2018;3:58–69 DOI: 10.1302/2058-5241.3.170044

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Section: Complicationsmentioning

confidence: 99%

Reverse total shoulder arthroplasty

Familiari¹,

et al. 2018

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“…Crosby et al [18] described 3 scapular spine fractures that appeared to propagate from the tip of the superior screw for the fixation of the glenoid baseplate. The authors suggested that these screws acted as stress risers and they tried to confirm their hypothesis with a biomechanical experiment [25]. However, the experimental setup was designed to test the resistance of a glenoid component under a force directed from the humerus to the scapula.…”

Section: Discussionmentioning

confidence: 99%

“…The short-and mid-term results are good [1,2]; the rate of peri-and postoperative problems and complications, however, is relatively high [3][4][5][6]. They include limited range of motion [7][8][9], scapular notching [10,11], instability [12,13], component loosening [3,14,15] and fractures of the acromion and scapular spine [16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

“…The cause of these fractures is still controversial. Some authors consider them as stress fractures [ 16 , 17 , 22 – 24 , 26 ] or bone injuries associated with osteoporosis [ 19 , 21 , 29 ], acromioclavicular (AC) joint osteoarthritis [ 24 ] or a drill hole close to the scapular spine for the fixation of the glenoid base plate [ 18 , 25 ]. Other authors believe that the design of the prosthesis [ 26 , 30 ], the location of the centre of rotation [ 29 , 31 ] or transection of the coracoacromial ligament plays a role [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

Nyffeler

Altioklar

Bissig

2020

International Orthopaedics (SICOT)

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Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.

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“…Over-tensioning can inadvertently increase the stresses across the scapular spine, leading to insufficiency fractures. Further reported causes of fractures include the placement of a superior metaglene screw and patient factors contributing to low bone mineral density, highlighting the multifactorial nature of this rare complication [6]. Incidence following RTSA is reported between 0.8% and 7.2% [5].…”

Section: Introductionmentioning

confidence: 99%

Scapular Spine Stress Fracture Following Reverse Total Shoulder Arthroplasty: Successful Management with Low-Intensity Pulsed Ultrasound

Wright

Tang

Ibrahim

2020

Cureus

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Scapular spine stress fractures are a rare but well-recognised complication following reverse total shoulder arthroplasty (RTSA). They present a challenge with no consensus on management. Both operative fixation and conservative measures are associated with high rates of mal-or non-union and decreased functional outcomes. We present the case of a 60-year-old female, who presented with a scapular spine fracture one year following RTSA. Treatment consisted of initial immobilisation, physiotherapy and the application of a portable low-intensity pulsed ultrasound (LIPUS) system (EXOGENÒ Ultrasound Bone Healing System, Bioventus, Durham NC, Netherlands). Following a three-month treatment course, there was a significant improvement in patient-reported pain and functional scores (Oxford Shoulder Score from 5/48 to 38/48). Sequential radiographic imaging confirmed fracture union. Clinicians may consider the use of LIPUS therapy as a potential adjunctive treatment modality to promote the union of scapular spine stress fractures following RTSA.

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Scapula fracture incidence in reverse total shoulder arthroplasty using screws above or below metaglene central cage: clinical and biomechanical outcomes

Cited by 63 publications

References 11 publications

Reverse total shoulder arthroplasty

Reverse total shoulder arthroplasty

Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

Scapular Spine Stress Fracture Following Reverse Total Shoulder Arthroplasty: Successful Management with Low-Intensity Pulsed Ultrasound

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