Abstract：
BACKGROUND: Fractures of the acromion and spine can have a major impact on the outcome of reverse shoulder arthroplasty (RSA) with respect to pain, motion, and function. Reports on internal fixation for these fractures are isolated to small series or case reports with variable outcomes. The purpose of this study was to report on the outcome of open reduction and internal fixation (ORIF) of acromion or spine fractures encountered before or after RSA and describe our evolution of fixation techniques.
METHODS: Between 2011 and 2023, 22 fractures or nonunions of the acromion or spine of the scapula underwent ORIF at a single institution and were followed for a minimum of 1 year. In 16 shoulders, fractures occurred after RSA, whereas 5 shoulders underwent ORIF prior to RSA. One shoulder had undergone prior failed ORIF elsewhere and revision ORIF was performed at our institution. There were 10 males and 12 females with a mean age of 67 (SD=15.1) years. Fixation strategies included single (n=11) and double plate fixation (n=11). Kruskal-Wallis one-way analyses of variance were used to analyze continuous variables and Chi-square tests employed for categorical variables.
RESULTS: Of the 5 fractures treated with ORIF pre-RSA, 1 shoulder suffered an additional fracture medial to the hardware and 1 required additional bone grafting for incomplete union at the time of RSA. These 5 shoulders all underwent RSA uneventfully, but one fracture experienced late displacement of the scapular spine nonunion, leading to plate removal. Of the 16 post-RSA ORIF shoulders, radiographic union was confirmed in 14 and substantial residual inferior angulation identified in 3. New fractures occurred after ORIF in 5 shoulders. For patients who underwent ORIF after RSA, pain scores improved from a mean of 8 to 1.9 points, with more modest elevation gains (58.2° to 91.3° pre- and postoperatively, respectively).
CONCLUSIONS: ORIF of acromion and scapular spine fractures or nonunions in the setting of RSA have the potential to lead to union. When these fractures and nonunions are encountered prior to RSA, ORIF allows for uneventful RSA implantation, but secondary displacement may occur. ORIF seems to lead to improvements in pain, but more modest improvements in motion and function. Our fixation strategy has evolved to (1) dual plating, (2) spanning the whole length of the spine with one of the plates, (3) use of hook features under the acromion or os trigonum if possible, and (4) liberal use of bone graft.
METHODS: Between 2011 and 2023, 22 fractures or nonunions of the acromion or spine of the scapula underwent ORIF at a single institution and were followed for a minimum of 1 year. In 16 shoulders, fractures occurred after RSA, whereas 5 shoulders underwent ORIF prior to RSA. One shoulder had undergone prior failed ORIF elsewhere and revision ORIF was performed at our institution. There were 10 males and 12 females with a mean age of 67 (SD=15.1) years. Fixation strategies included single (n=11) and double plate fixation (n=11). Kruskal-Wallis one-way analyses of variance were used to analyze continuous variables and Chi-square tests employed for categorical variables.
RESULTS: Of the 5 fractures treated with ORIF pre-RSA, 1 shoulder suffered an additional fracture medial to the hardware and 1 required additional bone grafting for incomplete union at the time of RSA. These 5 shoulders all underwent RSA uneventfully, but one fracture experienced late displacement of the scapular spine nonunion, leading to plate removal. Of the 16 post-RSA ORIF shoulders, radiographic union was confirmed in 14 and substantial residual inferior angulation identified in 3. New fractures occurred after ORIF in 5 shoulders. For patients who underwent ORIF after RSA, pain scores improved from a mean of 8 to 1.9 points, with more modest elevation gains (58.2° to 91.3° pre- and postoperatively, respectively).
CONCLUSIONS: ORIF of acromion and scapular spine fractures or nonunions in the setting of RSA have the potential to lead to union. When these fractures and nonunions are encountered prior to RSA, ORIF allows for uneventful RSA implantation, but secondary displacement may occur. ORIF seems to lead to improvements in pain, but more modest improvements in motion and function. Our fixation strategy has evolved to (1) dual plating, (2) spanning the whole length of the spine with one of the plates, (3) use of hook features under the acromion or os trigonum if possible, and (4) liberal use of bone graft.
摘要：
背景：肩峰和脊柱骨折可对反向肩关节成形术（RSA）的疼痛结果产生重大影响，动议，和功能。关于这些骨折的内固定的报告被隔离为具有可变结果的小系列或病例报告。这项研究的目的是报告在RSA之前或之后遇到的肩峰或脊柱骨折的切开复位内固定（ORIF）的结果，并描述我们固定技术的发展。
方法：在2011年至2023年之间，有22例肩胛骨肩峰或脊柱的骨折或不愈合在一个机构接受了ORIF治疗，并随访了至少1年。在16个肩膀上，RSA后发生骨折，而5肩在RSA之前接受ORIF。一个肩膀在其他地方经历了先前失败的ORIF，并且在我们的机构进行了修订ORIF。男性10例，女性12例，平均年龄67岁（SD=15.1）。固定策略包括单（n=11）和双钢板固定（n=11）。Kruskal-Wallis单向方差分析用于分析连续变量，卡方检验用于分类变量。
结果：在使用ORIF前RSA治疗的5处骨折中，1名肩部在硬件内侧遭受额外的骨折，1名在RSA时需要额外的植骨以进行不完全的愈合。这5个肩膀都顺利地接受了RSA，但是其中一个骨折出现了肩胛骨骨不连的晚期移位，导致板移除。在RSAORIF后的16个肩膀中，在14例中证实了放射学上的愈合，在3例中发现了大量残留的下角。5肩ORIF后出现新的骨折。对于RSA后接受ORIF的患者，疼痛评分从平均8分提高到1.9分，具有更适度的仰角增益（术前和术后58.2°至91.3°，分别)。
结论：在RSA的情况下，肩峰和肩胛骨骨折或不愈合的ORIF可能导致愈合。当在RSA之前遇到这些骨折和不愈合时，ORIF允许平稳的RSA植入，但可能会发生二次位移。ORIF似乎可以改善疼痛，但在运动和功能上有更适度的改善。我们的固定策略已经发展到(1)双电镀，（2）用其中一块板跨越脊柱的整个长度，(3)如果可能的话，在肩峰或三角下使用钩特征，和（4）自由使用骨移植物。
方法：在2011年至2023年之间，有22例肩胛骨肩峰或脊柱的骨折或不愈合在一个机构接受了ORIF治疗，并随访了至少1年。在16个肩膀上，RSA后发生骨折，而5肩在RSA之前接受ORIF。一个肩膀在其他地方经历了先前失败的ORIF，并且在我们的机构进行了修订ORIF。男性10例，女性12例，平均年龄67岁（SD=15.1）。固定策略包括单（n=11）和双钢板固定（n=11）。Kruskal-Wallis单向方差分析用于分析连续变量，卡方检验用于分类变量。
结果：在使用ORIF前RSA治疗的5处骨折中，1名肩部在硬件内侧遭受额外的骨折，1名在RSA时需要额外的植骨以进行不完全的愈合。这5个肩膀都顺利地接受了RSA，但是其中一个骨折出现了肩胛骨骨不连的晚期移位，导致板移除。在RSAORIF后的16个肩膀中，在14例中证实了放射学上的愈合，在3例中发现了大量残留的下角。5肩ORIF后出现新的骨折。对于RSA后接受ORIF的患者，疼痛评分从平均8分提高到1.9分，具有更适度的仰角增益（术前和术后58.2°至91.3°，分别)。
结论：在RSA的情况下，肩峰和肩胛骨骨折或不愈合的ORIF可能导致愈合。当在RSA之前遇到这些骨折和不愈合时，ORIF允许平稳的RSA植入，但可能会发生二次位移。ORIF似乎可以改善疼痛，但在运动和功能上有更适度的改善。我们的固定策略已经发展到(1)双电镀，（2）用其中一块板跨越脊柱的整个长度，(3)如果可能的话，在肩峰或三角下使用钩特征，和（4）自由使用骨移植物。
