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Scapular fractures osteosynthesis via Judet’s posterior approach: clinical and radiographic results

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Abstract  

Purpose

Scapular fractures are uncommon and mainly treated nonoperatively. Judet’s posterior approach allows access to the fracture site through the infraspinatus fossa and may be a technical option when ORIF is decided. The aims of this study were to determine clinical and radiographic outcomes of patients who underwent scapular body and/or glenoid fractures fixation via Judet’s posterior approach.

Methods

We conducted a retrospective single-centre study, and all patients admitted for scapular fracture who underwent osteosynthesis via Judet’s approach between January 2014 and September 2021 were included. At a minimum follow-up of one year, clinical outcomes were analyzed through subjective shoulder value (SSV) and Constant-Murley score (CMS). Strength in external rotation was measured in adduction and in 90° abduction and compared to healthy side. Radiographic analysis evaluated postoperative fracture reduction on CT scan and glenohumeral osteoarthritis according to Samilson’s classification at last follow-up.

Results

Twenty-one patients were included with a mean follow-up of 44.9 months. Mean SSV, CMS, and adjusted CMS were 73.8% ± 21.0, 65.8 points ± 19.5, and 72.8% ± 20.8, respectively. Strength in external rotation in adduction of the affected shoulder showed significant impairment when compared with the contralateral side (respectively 7.79 kg ± 4.29 and 12.0 kg ± 3.84, p = 0.02). All fractures healed uneventfully, but five patients (23.8%) required early revision surgery for intra-articular screws in three. Intra-articular gap measure decreased from 3.75 mm ± 1.93 in preoperative to 0.59 mm ± 0.97 after ORIF. The rate of arthritis was 15% at last follow-up.

Conclusion

Patients who underwent scapular fracture osteosynthesis via Judet’s posterior approach exhibited satisfactory but incomplete recovery of the affected shoulder as evidenced by functional scores and external rotation strength measurements at a mean follow-up of 44.9 months. Because of the risk of intra-articular screws, postoperative CT scan is mandatory.

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Data Availability

The data that support the findings of this study are available from the corresponding author, ED, upon reasonable request.

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Authors and Affiliations

  1. Département d’Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France

    Emile Dobelle, Suzanne Robert, Nicolas Gaujac, Pierre Laumonerie, Pierre Mansat & Nicolas Bonnevialle

  2. Clinique Universitaire du Sport, Toulouse, France

    Emile Dobelle, Suzanne Robert, Nicolas Gaujac, Pierre Laumonerie, Pierre Mansat & Nicolas Bonnevialle

  3. Institut de Recherche Riquet (I2R), Toulouse, France

    Pierre Mansat & Nicolas Bonnevialle

Authors
  1. Emile Dobelle
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  2. Suzanne Robert
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  3. Nicolas Gaujac
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  4. Pierre Laumonerie
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  5. Pierre Mansat
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  6. Nicolas Bonnevialle
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Emile Dobelle, Suzanne Robert, Nicolas Gaujac, Pierre Laumonerie, Pierre Mansat, and Nicolas Bonnevialle. The first draft of the manuscript was written by Emile Dobelle, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Emile Dobelle.

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Ethics approval

This is an observational study. According to the French Ethic and Regulatory Law (Public Health Code), retrospective studies based on the exploitation of usual care data should not be submitted at an ethic committee, but they have to be declared or covered by reference methodology of the French National Commission for Informatics and Liberties (CNIL).

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All participants gave informed consent to participate to this study and informed consent to publish their data.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1, 2, and 3.

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The authors declare no competing interests.

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Dobelle, E., Robert, S., Gaujac, N. et al. Scapular fractures osteosynthesis via Judet’s posterior approach: clinical and radiographic results. International Orthopaedics (SICOT) 47, 1557–1564 (2023). https://doi.org/10.1007/s00264-023-05754-5

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