Mejia Bustamante Alejandro, Arias Perez Ruben Dario, Ramirez Carmona Laura Ximena, Calle Diaz Sebastian
Clínica Universitaria Bolivariana, Medellín, Colombia.
Pontifical Bolivarian University, Medellín, Colombia.
Eur J Orthop Surg Traumatol. 2025 Jun 19;35(1):257. doi: 10.1007/s00590-025-04355-9.
Although surgical stabilization for displaced extra-articular scapular fractures is increasingly utilized, there remains limited evidence on predictors of functional recovery. This study aimed to evaluate long-term functional and radiographic outcomes after stabilization using the Brodsky posterior approach and to determine whether glenopolar angle or lateral border medialization independently predicts postoperative function. We hypothesized that improved radiographic parameters would be associated with better outcomes.
This retrospective cohort included 16 patients with displaced extra-articular scapular fractures treated with open reduction and internal fixation via the Brodsky approach. Functional recovery was assessed using the Constant score at 48 months postoperatively. Pre- and postoperative glenopolar angle and lateral border medialization were measured. Paired comparisons and multiple linear regression were used to identify predictors of outcome.
All patients achieved full fracture union without complications or need for reoperation. The median Constant score of the operated shoulder was 94 (IQR 88-95), compared to 96 (IQR 93-96) in the contralateral shoulder (p = 0.002). Despite statistical significance, the 2-point difference did not exceed the minimal clinically important difference for shoulder function. Postoperative improvements in glenopolar angle and medialization were significant. The contralateral Constant score was the only independent predictor of postoperative outcome (β = 1.52, p = 0.001). Radiographic variables were not predictive.
The Brodsky approach yields excellent long-term outcomes. Although radiographic correction is achieved, the preoperative function of the contralateral shoulder remains the most reliable indicator of postoperative recovery potential.
尽管手术稳定治疗移位的关节外肩胛骨折的应用越来越广泛，但关于功能恢复预测因素的证据仍然有限。本研究旨在评估采用布罗德斯基后入路稳定治疗后的长期功能和影像学结果，并确定肩胛极角或外侧缘内移是否能独立预测术后功能。我们假设影像学参数的改善将与更好的结果相关。
本回顾性队列研究纳入了16例采用布罗德斯基入路切开复位内固定治疗的移位关节外肩胛骨折患者。术后48个月使用Constant评分评估功能恢复情况。测量术前和术后的肩胛极角和外侧缘内移情况。采用配对比较和多元线性回归来确定结果的预测因素。
所有患者均实现骨折完全愈合，无并发症或再次手术的需要。患侧肩部的Constant评分中位数为94（四分位间距88 - 95），对侧肩部为96（四分位间距93 - 96）（p = 0.002）。尽管具有统计学意义，但2分的差异未超过肩部功能的最小临床重要差异。术后肩胛极角和内移情况有显著改善。对侧Constant评分是术后结果的唯一独立预测因素（β = 1.52，p = 0.001）。影像学变量无预测作用。
布罗德斯基入路可产生优异的长期结果。尽管实现了影像学矫正，但对侧肩部的术前功能仍然是术后恢复潜力最可靠的指标。
