Scapula insufficiency fractures after reverse total shoulder arthroplasty in rotator cuff arthropathy: What is their functional impact?

Abstract

Introduction-objectives: To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy.

Material and method: A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D).

Results: The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P>.05); postoperative Constant score: 81.2 and 66.5%, respectively (P>.001). Forward elevation and abduction in fracture patients decreased by 39° (P=.02), and 34° (P=.057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P=.002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months.

Conclusions: Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication.

Keywords: Acromial base fractures; Acromial fractures; Artroplastia invertida; Fracturas de acromion; Fracturas de escápula; Fracturas de la base del acromion; Fracturas por insuficiencia; Insufficiency Fracture; Reverse shoulder arthroplasty; Scapular fracture.