Cassidy J Tristan, Paszicsnyek Alexander, Ernstbrunner Lukas, Ek Eugene T
Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC 3181, Australia.
Department of Orthopaedic Surgery and Traumatology, General Hospital Oberndorf, Paracelsusstraße 37, 5110 Oberndorf, Austria.
J Clin Med. 2022 Nov 28;11(23):7025. doi: 10.3390/jcm11237025.
Fractures of the acromion and the scapular spine are established complications of reverse shoulder arthroplasty (RSA), and when they occur, the continuous strain by the deltoid along the bony fragments makes healing difficult. Evidence on treatment specific outcomes is poor, making the definition of a gold standard fixation technique difficult. The purpose of this systematic review is to assess whether any particular fixation construct offers improved clinical and/or radiographic outcomes. A systematic review of the literature on fixation of acromial and scapular spine fractures following RSA was carried out based on the guidelines of PRISMA. The search was conducted on PubMed, Embase, OVID Medline, and CENTRAL databases with strict inclusion and exclusion criteria applied. Methodological quality assessment of each included study was done using the modified Coleman methodology score to asses MQOE. Selection of the studies, data extraction and methodological quality assessment was carried out by two of the authors independently. Only clinical studies reporting on fixation of the aforementioned fractures were considered. Fixation construct, fracture union and time to union, shoulder function and complications were investigated. Nine studies reported on fixation strategies for acromial and scapular spine fractures and were therefore included. The 18 reported results related to fractures in 17 patients; 1 was classified as a Levy Type I fracture, 10 as a Levy Type II fracture and the remaining 7 fractures were defined as Levy Type III. The most frequent fixation construct in type II scapular spine fractures was a single plate (used in 6 of the 10 cases), whereas dual platin was the most used fixation for Levy Type III fractures (5 out of 7). Radiographic union was reported in 15 out of 18 fractures, whereas 1 patient (6.7%) had a confirmed non-union of a Levy Type III scapular spine fracture, requiring revision fixation. There were 5 complications reported, with 2 patients undergoing removal of metal and 1 patient undergoing revision fixation. The Subjective Shoulder Value and Visual Analogue Scale pain score averaged 75% and 2.6 points, respectively. The absolute Constant Score and the ASES score averaged 48.2 and 78.3 points, respectively. With the available data, it is not possible to define a gold standard surgical fixation but it seems that even when fracture union can be achieved, functional outcomes are moderate and there is an increased complication rate. Future studies are required to establish a gold standard fixation technique.
肩峰和肩胛冈骨折是反式肩关节置换术（RSA）的既定并发症，一旦发生，三角肌沿骨碎片产生的持续张力会使愈合变得困难。关于特定治疗结果的证据不足，因此难以定义金标准固定技术。本系统评价的目的是评估是否有任何特定的固定结构能带来更好的临床和/或影像学结果。根据PRISMA指南，对RSA术后肩峰和肩胛冈骨折固定的文献进行了系统评价。在PubMed、Embase、OVID Medline和CENTRAL数据库中进行检索，并应用严格的纳入和排除标准。使用改良的科尔曼方法评分对每项纳入研究的方法学质量进行评估，以评估方法学质量和结果的可解释性（MQOE）。研究的选择、数据提取和方法学质量评估由两位作者独立进行。仅考虑报告上述骨折固定情况的临床研究。对固定结构、骨折愈合及愈合时间、肩关节功能和并发症进行了调查。九项研究报告了肩峰和肩胛冈骨折的固定策略，因此被纳入。报告的18个结果涉及17例患者的骨折；1例为Levy I型骨折，10例为Levy II型骨折，其余7例骨折被定义为Levy III型。II型肩胛冈骨折最常用的固定结构是单钢板（10例中有6例使用），而双钢板是Levy III型骨折最常用的固定方式（7例中有5例）。18例骨折中有15例报告影像学愈合，而1例患者（6.7%）确诊为Levy III型肩胛冈骨折不愈合，需要翻修固定。报告了5例并发症，2例患者接受了金属取出术，1例患者接受了翻修固定。主观肩关节评价值和视觉模拟评分疼痛评分平均分别为75%和2.6分。绝对常数评分和ASES评分平均分别为48.2分和78.3分。根据现有数据，无法定义金标准手术固定方式，但似乎即使实现了骨折愈合，功能结果也一般，且并发症发生率有所增加。未来需要开展研究以确立金标准固定技术。
