Department of Orthopedic Surgery, Nassau University Medical Center, East Meadow, NY, USA.
Department of Orthopedic Surgery, Medical City University of Northern Texas/Texas Christian University, Dallas, TX, USA.
J Shoulder Elbow Surg. 2024 Dec;33(12):2743-2754. doi: 10.1016/j.jse.2024.05.042. Epub 2024 Jul 22.
The majority of scapula fractures have historically been treated nonoperatively. The current literature describing patient outcomes following scapula fractures is limited. Our objective was to determine differences in outcomes between operatively and nonoperatively treated scapular fractures. The goal of our study was to provide an updated and comprehensive systematic review for scapula body, neck, and glenoid fractures focusing on several outcomes including union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and any recorded complication.
The PRISMA methodology was followed for this systematic review. Articles were obtained from the PubMed/Medline database using the following search terms: scapula body OR scapula neck OR intra-articular glenoid AND fracture. Additional articles were obtained by searching the bibliographies of included references. Studies were included if they contained clinical data on one or more of our study objectives and contained participants with a scapular body, neck, and/or glenoid fracture who were at least 16 year old. A total of 35 papers, with 822 total cases were included. Studies chosen were assessed for level of evidence and reviewed for data pertaining to the current study objectives. All cases of scapula fractures found throughout the literature were analyzed for outcome data. Outcomes studied included union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and recorded complications.
The overwhelming majority of scapula fractures go on to union. The majority of patients will eventually return to work. Persistent postinjury pain is unfortunately common. Shoulder range of motion and strength are decreased when compared to the contralateral shoulder. Nonoperative glenoid fractures have the lowest reported functional scores. Malunion, need for additional surgeries, and post-traumatic arthritis were the most common complications.
When treating scapula fractures, orthopedic surgeons must consider the specific fracture pattern, as well as patient specific goals. Risks and benefits of both operative and nonoperative management should be discussed with the patient including the exceptionally low nonunion rate regardless of treatment option and that persistent pain following injury is unfortunately common.
大多数肩胛骨骨折既往采用非手术治疗。目前有关肩胛骨骨折患者结局的文献有限。我们的目的是确定手术和非手术治疗肩胛骨骨折的结局差异。本研究的目的是提供一个更新和全面的系统综述，重点关注肩胛骨体、颈和关节盂骨折的几个结局，包括愈合率、重返工作、疼痛、肩部主动活动范围、力量、功能评分以及任何记录的并发症。
本系统综述遵循 PRISMA 方法。使用以下搜索词从 PubMed/Medline 数据库中获取文章：肩胛骨体、肩胛骨颈、关节内关节盂和骨折。通过搜索纳入参考文献的参考文献获取额外的文章。如果研究包含我们研究目标之一的临床数据，且包含至少 16 岁的肩胛骨体、颈和/或关节盂骨折患者，则纳入研究。共纳入 35 篇论文，共计 822 例。选择的研究评估了证据水平，并对与当前研究目标相关的数据进行了审查。对文献中发现的所有肩胛骨骨折病例进行了结局数据分析。研究的结局包括愈合率、重返工作、疼痛、肩部主动活动范围、力量、功能评分和记录的并发症。
绝大多数肩胛骨骨折最终愈合。大多数患者最终会重返工作岗位。受伤后持续性疼痛不幸很常见。与对侧肩部相比，肩部活动范围和力量降低。非手术治疗的关节盂骨折报告的功能评分最低。畸形愈合、需要额外手术和创伤后关节炎是最常见的并发症。
治疗肩胛骨骨折时，骨科医生必须考虑特定的骨折模式以及患者的具体目标。应与患者讨论手术和非手术治疗的风险和益处，包括无论治疗选择，非愈合率都非常低，以及受伤后持续性疼痛不幸很常见。
