Five to ten-year outcomes of operatively treated scapular fractures
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BACKGROUND: The purpose of this study was to assess the 5 to 10-year clinical and patient-reported functional outcomes after open reduction and internal fixation (ORIF) of intra-articular and extra-articular scapular fractures. METHODS: We conducted a retrospective review of prospectively collected data on 106 patients who underwent ORIF of a scapular fracture at a single level-I trauma center between January 2005 and December 2010. Eight patients were excluded from the study because they had either severe neurologic injury or an isolated process fracture, and 66 patients (37 with an isolated extra-articular fracture and 29 with an intra-articular fracture) participated in the 5 to 10-year follow-up, yielding a follow-up rate of 67%. A physical examination including a strength assessment and range-of-motion measurements was performed on 89% of the follow-up cohort. Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-12 version 2 (SF-12v2) or SF-36v2 questionnaires were completed by all participating patients. Intra-articular and extra-articular fractures were analyzed in separate groups. RESULTS: The mean follow-up was 7.8 years in the extra-articular group and 7.3 years in the intra-articular group, with a range of 4.7 to 10.3 years. The mean DASH score was 8.9 in the extra-articular group and 9.1 in the intra-articular group (normal population = 10.1). Strength examination revealed no significant differences between the injured and uninjured shoulders for any movement (p > 0.05), while the range of external rotation was slightly decreased in both the extra-articular (p = 0.01) and the intra-articular (p = 0.01) group. The abduction range of motion was also slightly decreased in the intra-articular cohort (p = 0.03). Arthroplasty was indicated as a subsequent procedure for 2 patients in the intra-articular cohort. Sixty-one of the 66 patients returned to their original occupation or changed occupations for reasons unrelated to the shoulder injury. CONCLUSIONS: At 5 to 10 years after ORIF of a scapular fracture, patients have excellent functional outcomes albeit with a small decrease in external rotation motion relative to the contralateral, normal shoulder. Interestingly, we found the outcomes after intra-articular and extra-articular fractures to be comparable. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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