Skip to main content
SpringerLink
Log in

Scapula Fractures After Reverse Total Shoulder Arthroplasty: Classification and Treatment

  • Symposium: Reverse Total Shoulder Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Reverse total shoulder arthroplasty (RTSA) implants have been developed to treat patients with deficient rotator cuffs. The nature of this procedure’s complications and how these complications should be managed continues to evolve. Fractures of the scapula after RTSA have been described, but the incidence and best methods of treatment are unclear.

Questions/purposes

We therefore (1) determined the incidence and (2) developed a classification system intended to suggest the best choice of treatment.

Patients and Methods

We reviewed the records of 400 patients treated with RTSA over 4.5 years and identified all patients with scapula fractures. We identified three discrete patterns: avulsion fractures of the anterior acromion (Type I); fractures of the acromion posterior to the acromioclavicular joint (Type II); and fractures of the scapular spine (Type III).

Results

Twenty-two patients (5.5%) had fractures. Eight (2.0%) had Type I fractures on the first followup radiographs; these patients were treated nonoperatively with resolution of symptoms. Ten (2.5%) had Type II fractures a mean of 10.8 months after RTSA; seven of the 10 were treated surgically with improvement in their clinical symptoms. Four (1%) had Type III fractures at a mean of 10.3 months; all four fractures were treated with surgical fixation with healing.

Conclusions

Scapula fracture is a relatively common complication of RTSA. Our observations suggest Type I fractures can be observed with a likelihood of symptom relief. For Type II fractures, we recommend acromioclavicular joint resection if stable but open reduction internal fixation if unstable. We believe Type III fractures are best treated with open reduction internal fixation.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bohsali K, Wirth M, Rockwood C. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88:2279–2292.

    Article  PubMed  Google Scholar 

  2. Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87:1967–1705.

    Article  Google Scholar 

  3. Grammont P, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65–68.

    PubMed  CAS  Google Scholar 

  4. Matsen FA, Boileau P, Walch G, Gerber C, Bicknell RT. The reverse total shoulder arthroplasty. Inst Course Lect. 2008;57:167–174.

    Google Scholar 

  5. Nwakama A, Cofield R, Kavvanagh B, Loehr J. Semiconstrained total shoulder arthroplasty for glenohumeral arthritis and massive rotator cuff tearing. J Shoulder Elbow Surg. 2000;9:302–307.

    Article  PubMed  CAS  Google Scholar 

  6. Rittmeister M, Kerschbaumer F. Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg. 2001;10:17–22.

    Article  PubMed  CAS  Google Scholar 

  7. Seebaur L, Walter W, Key W. Reverse total shoulder arthroplasty for the treatment of defect arthropathy. Oper Orthop Traumatol. 2005;17:1–24.

    Article  Google Scholar 

  8. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. J Bone Joint Surg Br. 2004;86:388–385.

    Article  Google Scholar 

  9. Werner C. Stienmann P, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–1486.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Medical College of Georgia, 1120 15th Street, BP 2108, Augusta, GA, 30912, USA

    Lynn A. Crosby MD & Todd Twiss MD

  2. Wright State Department of Orthopedics, Dayton, OH, USA

    Adam Hamilton MD

Authors
  1. Lynn A. Crosby MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam Hamilton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Todd Twiss MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lynn A. Crosby MD.

Additional information

One of the authors (LAC) has received royalties and consulting fees from Exactech (Gainesville, FL) for a product related to this study.

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Wright State University Boonshoft School of Medicine, Dayton, OH, USA, and the Medical College of Georgia, Augusta, GA, USA.

About this article

Cite this article

Crosby, L.A., Hamilton, A. & Twiss, T. Scapula Fractures After Reverse Total Shoulder Arthroplasty: Classification and Treatment. Clin Orthop Relat Res 469, 2544–2549 (2011). https://doi.org/10.1007/s11999-011-1881-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-1881-3

Keywords

Search

Navigation