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Researchers recommend alternate classification for scapular fractures after reverse shoulder arthroplasty
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Researchers found osteoporosis was a significant risk factor in this study of scapular fracture after reverse shoulder arthroplasty, and that plain radiographs were moderately reliable in determining the presence of scapular fractures after the procedure.
“The accuracy of diagnosing scapular fractures after [reverse shoulder arthroplasty] RSA on plain radiographs was only 78.8%, suggesting that additional imaging studies may be necessary to confirm the diagnosis,” Randall J. Otto, MD, and colleagues wrote in the study.
Otto and colleagues performed a retrospective review of 53 patients who underwent RSA, identifying comorbidities and using independent reviewers to identify scapular fractures on plain radiographs to test a proposed classification, according to the abstract. The patients’ results were compared to 212 control patients who were matched for age, gender, indication for RSA and time to surgery.
The researchers found osteoporosis was a significant risk factor for scapular fractures, but there was no significant difference for other comorbidities. The independent reviewers correctly identified scapular fractures in 78.8% of cases in the fracture group and in 97.4% of cases in the control group with “good inter-rater reliability and excellent intra-rater reliability,” and the researchers noted the inter-rater reliability was moderate, according to the abstract.
“A significant difference occurred between groups from the postoperative radiographs to the most recent radiographs for [acromial tilt] distance (0.4 ± 5.5 mm for control group and 8.3 ± 7.6 mm for fracture group) and acromial tilt (1.8° ± 6.3° for control group and 14° ± 15° for fracture group),” Otto and colleagues wrote. “Of 16 scapular spine fractures, 14 occurred from a screw tip; however, screw orientation and length were not different between groups.”
Disclosure: Virani received institutional research support from DJO. Levy and Frankle are paid consultants for and receive royalties from DJO. Cuff is a paid consultant for DJO and Arthrex.
This study was funded by an institutional research grant to the Foundation for Orthopaedic Research and Education from DJO.
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