Presenter’s name (Last, First): Mcilwain, Elysse

Qualifications: BMedSc/BMedSc(Hons)/MBBS

Affiliations: John Hunter Hospital (Hunter New England Local Health District), Newcastle, Australia

Other authors:
Dr Minas Petrelis / Orthopaedic Surgeon / JohnHunter Hospital.

Dr Gajan Selvakumaran / Orthopaedic / John Hunter Hospital.

Dr Sarah Warby /Physiotherapist/Statistician / Melbourne Shoulder Group/La Trobe University, Melbourne

Email: elysse.mcilwain@gmail.com

Background / Introduction:
Scapular fractures are a postoperative complication following reverse total shoulder arthroplasty (rTSA). Patients with scapular fractures following rTSA experience inferior outcomes compared to those without. While operative management improved union rates, clinical outcomes are not found to be superior. The primary aim of this retrospective study was to evaluate the incidence and management of scapular fractures following rTSA. The secondary aim is to compare the clinical and functional outcomes of patients managed operatively versus conservatively.

Patients / Methods:
Consecutive, non-selective rTSA cases performed by one surgeon (M.P) in the public and private systems between June 2016 and December 2020 were retrospectively reviewed for postoperative scapula fractures. Patients who had rTSA performed for traumatic fracture were excluded. Patients identified to have sustained a postoperative scapular fracture were offered review involving clinical examination and completion of PROMs. The clinical and functional outcomes of those managed operatively were compared to those managed conservatively.

410 rTSA procedures were performed. Of the 342 patients included in the study, 15 patients (4.4%) sustained postoperative fractures. Seven patients were managed operatively and eight patients non-operatively. The mean time from rTSA to fracture diagnosis was 31.9 weeks(range 6.7 weeks to 183.9 weeks). There was no significant difference in mean time to fracture between the group managed conservatively compared to the group managed operatively. Risk factors for fracture were avascular necrosis as an indication for rTSA, previous shoulder injection and osteoporosis. Preliminary results demonstrate no significant difference between operative vs conservative management for PROMs.

In our retrospective cohort, the incidence rate for scapular fracture post rTSA was 4.4%, consistent with previously published literature. Risk factors for fracture were avascular necrosis as an indication for rTSA, previous shoulder injection and osteoporosis. This study provides confirmation that postoperative scapular fractures are an evident risk post rTSA.


Level of Evidence & Study type: 3- Retrospective, case control analysis

Declarations of Conflict: Dr Minas Petrelis has completed consulting work for DJO Surgical