scholarly journals Double plating is associated with higher fixation strength than single plating in osteoporotic fractures of the scapular spine: a biomechanical study

2021 ◽  
Author(s):  
J. Christoph Katthagen ◽  
Julia Sußiek ◽  
Andre Frank ◽  
Jens Wermers ◽  
Benedikt Schliemann ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Failure Load ◽  
Reverse Shoulder Arthroplasty ◽  
Fixation Strength ◽  
Osteoporotic Bone ◽  
Spine Fractures ◽  
Test Protocol ◽  
Machine Failure ◽  
Scapular Spine ◽  
Double Plating

Abstract Introduction The number of atraumatic stress fractures of the scapular spine associated with reverse shoulder arthroplasty is increasing. At present, there is no consensus regarding the optimal treatment strategy. Due to the already weakened bone, fractures of the scapular spine require a high fixation stability. Higher fixation strength may be achieved by double plating. The aim of this study was to evaluate the biomechanical principles of double plating in comparison to single plating for scapular spine fractures. Methods In this study, eight pairs (n = 16) of human shoulders were randomised pairwise into two groups. After an osteotomy at the level of the spinoglenoid notch, one side of each pair received fracture fixation with a single 3.5 LCP (Locking Compression Plate) plate. The contralateral scapular spine was fixed with a 3.5 LCP and an additional 2.7 LCP plate in 90–90 configuration. The biomechanical test protocol consisted of 700 cycles of dynamic loading and a load-to-failure test with a servohydraulic testing machine. Failure was defined as macroscopic catastrophic failure (screw cut-out, plate breakage). The focus was set on the results of specimens with osteoporotic bone quality. Results In specimens with an osteoporotic bone mineral density (BMD; n = 12), the mean failure load was significantly higher for the double plate group compared to single plating (471 N vs. 328 N; p = 0.029). Analysis of all specimens (n = 16) including four specimens without osteoporotic BMD revealed no significant differences regarding stiffness and failure load (p > 0.05). Conclusion Double plating may provide higher fixation strength in osteoporotic bone in comparison to a single plate alone. This finding is of particular relevance for fixation of scapular spine fractures following reverse shoulder arthroplasty. Level of evidence Controlled laboratory study.

scholarly journals Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

2020 ◽  
Vol 44 (12) ◽  
pp. 2673-2681
Author(s):  
Richard W. Nyffeler ◽  
Bartu Altioklar ◽  
Philipp Bissig
Keyword(s):  
Bone Quality ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Control Group ◽  
Time Interval ◽  
Spine Fractures ◽  
Poor Bone Quality ◽  
Significant Deterioration ◽  
Scapular Spine

Abstract Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.

How common are acromial and scapular spine fractures after reverse shoulder arthroplasty?

2019 ◽  
Vol 101-B (6) ◽  
pp. 627-634 ◽  
Author(s):  
J. J. King ◽  
S. S. Dalton ◽  
L. V. Gulotta ◽  
T. W. Wright ◽  
B. S. Schoch
Keyword(s):  
Incidence Rate ◽  
Shoulder Arthroplasty ◽  
Inflammatory Arthritis ◽  
English Literature ◽  
Reverse Shoulder Arthroplasty ◽  
Revision Arthroplasty ◽  
Fracture Rate ◽  
Spine Fractures ◽  
Wide Range ◽  
Scapular Spine

Aims Acromial fractures following reverse shoulder arthroplasty (RSA) have a wide range of incidences in reported case series. This study evaluates their incidence following RSA by systematically reviewing the current literature. Materials and Methods A systematic review using the search terms “reverse shoulder”, “reverse total shoulder”, or “inverted shoulder” was performed using PubMed, Web of Science, and Cochrane databases between 1 January 2010 and 31 March 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Studies were included if they reported on RSA outcomes and the incidence rate of acromial and/or scapular spine fractures. The rate of these fractures was evaluated for primary RSA, revision RSA, RSA indications, and RSA implant design. Results The review included 90 articles out of 686 identified after exclusions. The incidence rate of acromial and/or scapular spine fractures was 2.8% (253/9048 RSAs). The fracture rate was similar for primary and revision RSA (2.8% vs 2.1%; p = 0.4). Acromial fractures were most common after RSA for inflammatory arthritis (10.9%) and massive rotator cuff tears (3.8%). The incidence was lowest in RSA for post-traumatic arthritis (2.1%) and acute proximal humerus fractures (0%). Lateralized glenosphere design had a significantly higher rate of acromial fractures compared with medial glenosphere designs. Conclusion Based on current English literature, acromial and/or scapular spine fractures occur at a rate of 2.8% after RSA. The incidence is slightly more common after primary compared with revision arthroplasty. Also, higher rates of acromial fractures are reported in RSA performed for inflammatory arthritis and in the lateralized glenoid design. Cite this article: Bone Joint J 2019;101-B:627–634.

scholarly journals Locked 90°-double plating of scapular spine fracture after reverse shoulder arthroplasty with union and good outcome despite plate adjacent acromion fracture

2020 ◽  
Vol 13 (9) ◽  
pp. e234727
Author(s):  
Stefan Bauer ◽  
Aurélien Traverso ◽  
Gilles Walch
Keyword(s):  
Shoulder Arthroplasty ◽  
Open Reduction ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Union Rate ◽  
Non Union ◽  
Good Outcome ◽  
Acromion Fracture ◽  
Scapular Spine ◽  
Double Plating

We report the case of a 74-year-old woman who sustained a scapular spine (SS) fracture after a fall 4 weeks after reverse shoulder arthroplasty (RSA). Open reduction and internal fixation (ORIF) with locked 90°-double plating resulted in union of the SS fracture with a good outcome (subjective shoulder value: 80%; Constant score 67; 1 year) despite of an adjacent lateral acromion fracture 3 weeks after ORIF. This is the second description in the literature of a successful double plate ORIF with union of an SS fracture after RSA. SS fractures are known to lead to poor RSA outcomes with a high mal-union rate and non-union rate. We describe the positioning of the plates and technical steps for successful ORIF to avoid complications, discuss the aftercare and report the outcome.

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

2018 ◽  
Vol 27 (12) ◽  
pp. 2183-2190 ◽  
Author(s):  
Francesco Ascione ◽  
Christopher M. Kilian ◽  
Mitzi S. Laughlin ◽  
Giulia Bugelli ◽  
Peter Domos ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Short Stem ◽  
Spine Fractures ◽  
Scapular Spine

scholarly journals Scapular spine base fracture with long outside-in superior or posterior screws with reverse shoulder arthroplasty

2021 ◽  
Vol 24 (3) ◽  
pp. 141-146
Author(s):  
Osman Nuri Eroğlu ◽  
Buğra Hüsemoğlu ◽  
Onur Başçı ◽  
Mustafa Özkan ◽  
Hasan Havıtçıoğlu ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Failure Load ◽  
Statistical Significance ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Control Group ◽  
Fresh Cadaver ◽  
Acromion Fracture ◽  
Scapular Spine ◽  
Spine Fixation

Background: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model.Methods: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulas to the study group (spine base fixation with a 4-inch-long superior screw, three with both long superior and long posterior screws).Results: The failure load was lower in the spine fixation group (long screw [869 N] vs. short screw [1,123 N]); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine.Conclusions: The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.

scholarly journals Reverse Shoulder Arthroplasty, Deltopectoral Approach vs. Anterosuperior Approach: An Overview of the Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Paraskevas Georgoulas ◽  
Aliki Fiska ◽  
Athanasios Ververidis ◽  
Georgios I. Drosos ◽  
Evanthia Perikleous ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Shoulder Arthroplasty ◽  
Large Scale ◽  
Reverse Shoulder Arthroplasty ◽  
Clinical Effectiveness ◽  
Surgical Approaches ◽  
Cuff Tear ◽  
Scapular Spine ◽  
Deltopectoral Approach

Reverse shoulder arthroplasty (RSA) has become an optimal treatment for numerous orthopedic entities, such as rotator cuff tear arthropathies, pseudoparalysis, fracture sequelae, acute fractures, failed arthroplasties, osteoarthritis, and rheumatoid arthritis, and is linked with relief of topical pain and regaining of functionality. Presently, RSA has been conducted through anterosuperior (AS) or deltopectoral (DP) approach. The aim of the study was to discuss both approaches and to examine broadly their features to render a comparison in terms of clinical effectiveness. An electronic search in PubMed, EMBASE, and Google Scholar databases was performed, using combinations of the following keywords: RSA, DP approach, AS approach, notching, and cuff tear arthropathy. A total of 61 studies were found, and 16 relevant articles were eventually included. Currently published literature has not shown significant diversities in the clinical course due to approach preference; risk of instability seems to be greater in DP approach, while regarding scapular notching and fracture rates the findings were conflicted. In addition, the AS approach has been associated with decreased risk of acromial and scapular spine fractures. In conclusion, both surgical approaches have shown similar clinical outcomes and effectiveness concerning pain and restoring range of motion (ROM) in rotator cuff tear arthropathies. In the future, further investigations based on large-scale well-designed studies are required to address clinical gaps allowing in-depth comparison of both approaches.

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