Schenk Pascal, Aichmair Alexander, Beeler Silvan, Jentzsch Thorsten, Gerber Christian
Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
J Shoulder Elbow Surg. 2022 Oct;31(10):2076-2081. doi: 10.1016/j.jse.2022.03.005. Epub 2022 Apr 18.
Acromial and scapular spine fractures are common complications after reverse total shoulder arthroplasty (RTSA). There is limited information on the treatment outcome of these fractures. Therefore, the purpose of this study was to compare the clinical outcome of operative and conservative treatment of patients with acromial or scapular spine fractures.
A total of 1146 RTSAs were performed in our institution between 1999 and 2016. In 23 patients (2%), we identified an acromial fracture, and in 7 cases (0.6%), a scapular spine fracture in the postoperative course. Of those patients, 7 patients (23%) were treated with open reduction and internal fixation and 23 (77%) were treated conservatively. We compared the outcome of operative vs. conservative treatment assessing the Constant score (CS), range of motion, and subjective shoulder value (SSV). Fractures were classified by the system of Crosby. Radiographic assessment consisted of measuring the healing rate, time to heal, and the displacement of the acromion before and immediately after the fracture as well as after treatment.
There were no statistically significant differences between operative and conservative treatment. The mean preoperative CS in the operative group was 32 points and improved to 45 points after surgery, whereas it was 35 points in the conservative group and improved to 61 points at the final follow-up. The mean SSV improved from 20 to 50 points in the operative group and from 22 to 58 points in the conservative group. Mean active flexion changed from 59° to 75°, mean abduction from 68° to 67°, and external rotation from 25° to 13° in the operative group and from 75° to 91°, 67° to 92°, and 28° to 24° in the conservative group.
In our study, operative treatment was not superior to conservative treatment, neither for CS, SSV, or range of motion. Both treatment forms, however, resulted in inferior results to those previously reported for RTSA without postoperative acromion fractures. Before better surgical methods have been developed, conservative treatment of acromial fractures may be the better treatment option for acromial fractures after RTSA.
肩峰和肩胛冈骨折是反式全肩关节置换术（RTSA）后的常见并发症。关于这些骨折的治疗结果的信息有限。因此，本研究的目的是比较肩峰或肩胛冈骨折患者手术治疗与保守治疗的临床结果。
1999年至2016年期间，我们机构共进行了1146例RTSA手术。在23例患者（2%）中，我们在术后过程中发现了肩峰骨折，7例（0.6%）发现了肩胛冈骨折。在这些患者中，7例（23%）接受了切开复位内固定治疗，23例（77%）接受了保守治疗。我们通过评估Constant评分（CS）、活动范围和主观肩关节评分（SSV）来比较手术治疗与保守治疗的结果。骨折采用Crosby系统进行分类。影像学评估包括测量愈合率、愈合时间以及骨折前、骨折后即刻和治疗后肩峰的移位情况。
手术治疗与保守治疗之间无统计学显著差异。手术组术前平均CS为32分，术后提高到45分，而保守组术前为35分，末次随访时提高到61分。手术组平均SSV从20分提高到50分，保守组从22分提高到58分。手术组平均主动屈曲从59°变为75°，平均外展从68°变为67°，外旋从25°变为13°，保守组分别从75°变为91°、67°变为92°、28°变为24°。
在我们的研究中，无论是CS、SSV还是活动范围，手术治疗均不优于保守治疗。然而，两种治疗方式的结果均低于先前报道的无术后肩峰骨折的RTSA。在开发出更好的手术方法之前，RTSA后肩峰骨折的保守治疗可能是更好的治疗选择。
