Marigi Erick M, Eboh Stanley, Marigi Ian M, Sperling John W, Pierce Andrew S, Azar Fred M, Brolin Tyler J, Throckmorton Thomas W
Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Germantown, TN, USA.
J Shoulder Elbow Surg. 2025 Jun;34(6):1507-1513. doi: 10.1016/j.jse.2024.09.029. Epub 2024 Nov 22.
Periscapular fractures, specifically acromial and scapular spine fractures, have been identified as one of the leading complications of reverse total shoulder arthroplasty (rTSA). However, very little is known of the etiology of these postoperative fractures, or how variations in humeral designs correlates with the risk of postoperative fracture development. Therefore, the purpose of this study was to analyze the prevalence, timing, and relationship of humeral component design to acromial or scapular spine fractures.
A retrospective study was conducted of primary rTSA performed for elective and traumatic indications from 2 tertiary institutions. Exclusions consisted of primary oncologic reconstructions, diagnosis of osteogenesis imperfecta, and less than 1 year of clinical follow-up. A total of 3018 primary rTSAs were included with a cohort of 1739 (57.6%) females, a mean age of 71 years (range, 20-94 years), a mean body mass index of 30.6 ± 6.6, and a mean follow-up of 6.4 ± 3.8 years. The implants used varied based on surgeon preference and included 9 different types. The humeral component of the rTSA was categorized as an inlay design (n = 762; 25.2%), defined as a humeral component where the tray is seated within the metaphysis, or an onlay design (n = 2256; 74.8%) defined as a humeral component where the humeral tray sits on the metaphysis at the level of the humeral neck cut.
A fracture of the acromion or scapular spine was radiographically identified in 64 of 3018 (2.1%) rTSAs at an average of 8.5 ± 12.6 months after surgery. The majority of fractures included the acromion (n = 57; 89.1%) and scapular spine (n = 7; 10.9). Nonoperative management (n = 60; 93.8%) was the predominant treatment strategy for fractures, whereas 4 (6.2%) rTSAs underwent open reduction and internal fixation. When compared by humeral component design (inlay vs. onlay), there were no differences in the rates of acromial or scapular spine fractures (2.6% vs. 2.0%; P = .264). Similarly, there were no treatment differences between nonoperative (90% vs. 95.5%) and operative management (10% vs. 4.5%) of the fractures based on the type of humeral component design (P = .403).
Acromial and scapular spine fractures complicated the postoperative course of 2.1% of primary rTSAs when performed across 2 high-volume shoulder arthroplasty centers with multiple surgeons including a wide range of implant types. Most of the fractures involve the acromion, with less frequent involvement of the spine of the scapula. When comparing by inlay vs. onlay humeral component design, the rates of postoperative acromial or scapular spine fractures were statistically similar.
肩胛周围骨折，尤其是肩峰和肩胛冈骨折，已被确定为反式全肩关节置换术（rTSA）的主要并发症之一。然而，对于这些术后骨折的病因，或者肱骨设计的变化如何与术后骨折发生风险相关，我们知之甚少。因此，本研究的目的是分析肱骨组件设计与肩峰或肩胛冈骨折的发生率、发生时间及关系。
对来自2家三级医疗机构因择期和创伤性适应证进行的初次rTSA进行回顾性研究。排除标准包括原发性肿瘤重建、成骨不全的诊断以及临床随访时间不足1年。共纳入3018例初次rTSA，其中女性1739例（57.6%），平均年龄71岁（范围20 - 94岁），平均体重指数为30.6±6.6，平均随访时间为6.4±3.8年。使用的植入物因外科医生的偏好而异，包括9种不同类型。rTSA的肱骨组件分为嵌体设计（n = 762；25.2%），定义为托盘位于干骺端内的肱骨组件，或覆盖设计（n = 2256；74.8%），定义为肱骨托盘位于肱骨颈截骨水平的干骺端上的肱骨组件。
在3018例rTSA中，有64例（2.1%）在术后平均8.5±12.6个月时经X线检查发现肩峰或肩胛冈骨折。大多数骨折累及肩峰（n = 57；89.1%）和肩胛冈（n = 7；10.9%）。非手术治疗（n = 60；93.8%）是骨折的主要治疗策略，而4例（6.2%）rTSA接受了切开复位内固定。按肱骨组件设计（嵌体与覆盖）比较，肩峰或肩胛冈骨折发生率无差异（2.6%对2.0%；P = 0.264）。同样，基于肱骨组件设计类型，骨折的非手术治疗（90%对95.5%）和手术治疗（10%对4.5%）之间也没有治疗差异（P = 0.403）。
在2家有多名外科医生且使用多种植入物类型的大容量肩关节置换中心进行的初次rTSA中，肩峰和肩胛冈骨折使2.1%的患者术后病程复杂化。大多数骨折累及肩峰，肩胛冈受累较少。按嵌体与覆盖肱骨组件设计比较，术后肩峰或肩胛冈骨折发生率在统计学上相似。
