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Posterior subdeltoid and external rotators preserving approach for reduction and fixation of displaced extra-articular fractures of the scapula

  • Emmanouil Fandridis
  • Panagiotis P. AnastasopoulosEmail author
  • George Alexiadis
  • Dimitrios Nomikarios
  • Sarantis Spyridonos
  • Ralph Hertel
Original Article • SHOULDER - FRACTURES
  • 298 Downloads

Abstract

Background

Operative management of scapular body fractures, when indicated, typically involves extensive exposure through a posterior approach. We present our experience with a deltoid preserving approach that allows excellent exposure of the fracture lines for reduction and fixation while minimizing muscle detachment and overall tissue trauma.

Technique

Exposure of the scapula was obtained through a posterior incision. The posterior deltoid was exposed and retracted superiorly while the arm was abducted in accordance with Brodsky et al. The scapula was exposed in the interval between infraspinatus and teres minor.

Patients and methods

Six patients were treated using this approach and were retrospectively reviewed. All were men with a mean age of 34 years (range 24–45 ± 6.7 years). The injuries involved two 14-A3.1 and four 14-A3.2 AO/OTA types of fractures. The mean follow-up after surgery was 28 months (range 21–36 ± 4.93 months).

Results

All fractures could be anatomically reduced and healed without compromise. The mean Constant score was 93.8 (range 91–97 ± 2.13), while range of motion and strength returned to levels equal to the uninjured shoulder. All patients returned to their previous level of activity. We did not observe atrophy of the posterior muscles or hardware complications, and none required hardware removal.

Conclusion

The deltoid and external rotators preserving posterior approach permitted good visualization of the fractures while allowing reduction and fixation without extensive muscular dissection and provided excellent functional outcomes. We consider that it offers obvious advantages over more aggressive muscle detaching approaches.

Level of evidence

Therapeutic study, IV.

Keywords

Fractures Scapular body Deltoid Rotator cuff Posterior shoulder approach 

Notes

Compliance with ethical standards

Conflict of interest

The authors, their immediate family and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hand Surgery-Upper Limb and Microsurgery DepartmentKAT General HospitalAthensGreece
  2. 2.LindenhofspitalBernSwitzerland

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