X-ref For other Roundups in this issue that cross-reference with Shoulder & Elbow see: Trauma Roundup 3; Children’s orthopaedics Roundups 3 and 6.
Is surgery needed for extra-articular scapular fractures?
We suspect that the rarity of the injury and the technical difficulty of the surgery have a part to play in the decision-making process surrounding fixation, or otherwise, of scapular fractures. The indications for surgery are far from agreed, although the majority of surgeons would concur that for significantly displaced glenoid fractures, surgery should be considered. There is less consensus with extra-articular fractures, although the glenoid can be significantly displaced and this will alter the lever arm and mechanical advantages of the rotator cuff muscles. With a fresh look at what the operative indications in extra-articular fractures ought to be, surgeons from St Paul, Minnesota (USA) report the outcomes from their series.1 The authors were able to report the functional outcomes of 49 of 61 patients with acute operatively managed extra-articular scapular fractures. Functional outcomes were reported to 33 months following surgery, and the authors are open about the operative indications which are well documented in the paper and are based on the limited existing literature. The authors report a 100% union rate, with DASH and SF-36 scores approaching normative values for the population at 33 months of follow-up. Excellent strength and range of motion, compared with the contralateral arm, were also found in the group. There were nine complications apparent in eight patients, with implant removal and secondary manipulation of the shoulder under anaesthesia most commonly seen. The authors concluded that operatively managed displaced glenoid neck and scapular body fractures give expected good functional outcomes. There are two significant limitations to this large series of patients which somewhat hamper the interpretation of the results. Firstly there is no non-operative control group in the study, …