3 years ago

Increased scapular spine fractures after reverse shoulder arthroplasty with a humeral onlay short stem: an analysis of 485 consecutive cases

Francesco Ascione, Christopher M. Kilian, Mitzi S. Laughlin, Giulia Bugelli, Peter Domos, Lionel Neyton, Arnaud Godeneche, T. Bradley Edwards, Gilles Walch

Publication date: December 2018

Source: Journal of Shoulder and Elbow Surgery, Volume 27, Issue 12

Author(s): Francesco Ascione, Christopher M. Kilian, Mitzi S. Laughlin, Giulia Bugelli, Peter Domos, Lionel Neyton, Arnaud Godeneche, T. Bradley Edwards, Gilles Walch

Background

Scapular stress fractures after reverse shoulder arthroplasty (RSA) are a potentially serious complication with modern lateralized and onlay implants. The aim of this study was to report the scapular spine stress fracture rate after RSA with an onlay, 145° humeral stem, analyzing potential fracture risk factors and clinical outcomes in a large cohort of patients.

Methods

A consecutive series of 485 RSAs were implanted with the Aequalis Ascend Flex stem. Data collection included preoperative and postoperative clinical and radiographic assessment findings (rotator cuff Goutallier grade; Hamada, Walch, and Favard classifications; range of motion; Constant score) and perioperative data. Patients with a scapular spine fracture following RSA were matched with nonfracture control patients, and preoperative variables were tested to determine whether they were predictive of a scapular spine fracture.

Results

A scapular spine fracture following RSA occurred in 21 patients (4.3%), with a mean time to diagnosis of 8.6 months (range, 1-34 months). No preoperative factor was found to be a significant predictor of scapular spine fracture. Both groups showed significant improvements in active mobility measurements and Constant scores from preoperatively to final follow-up (P < .001). The control group scored significantly better than the scapular spine fracture group regarding the Constant score and forward flexion.

Conclusion

Scapular spine fractures have shown an increased prevalence after onlay-design RSA. This series was not able to link any clear risk factors. Functional results are limited, regardless of the fracture management.

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