Case Series Evaluating the Operative and Nonoperative Treatment of Scapular Fractures

This study addressed the relationship between concomitant chest wall injuries and recovery of shoulder function after scapular fracture. Previous studies have suggested that concomitant chest wall injuries, such as rib fractures, cause more pain and may adversely impact the return of function in patients who have sustained scapular body fractures.¹ These results, however, occurred in the setting of a much shorter follow-up, in which Disability of Arm, Shoulder, and Hand (DASH) surveys were distributed 6 months post-injury, 12 months post-injury, and once at last follow-up (<3 years). At our significantly later average follow-up, chest wall injuries did not portend a worse return of shoulder function, in contrast to our hypothesis. Our lack of findings of a worse return of function in patients with chest wall injuries, in light of previous literature, suggests that this association could become less distinct as the initial injury becomes more remote and has had more time to heal. Farther out from injury, patients seem to function similarly, regardless of chest wall injury history.

This study was limited by several factors. First, the surgically treated group was considerably smaller than the nonoperative group, which made drawing statistically significant comparisons between them challenging. Although there were no apparent differences between the group who completed ASES surveys and those who did not, only collecting ASES data on 153 of the 663 patients introduces a possible selection bias in this analysis. Additionally, due to the retrospective nature of this study, we were not able to ascertain the specific surgical indications used by individual surgeons. Again, the nature of this study also made it implausible to separate fractures beyond the simple 14A vs 14B/C classification. For example, we did not routinely have access to computed tomography scans to provide exact measurements of displacement, angulation, or step-off; therefore, we were unable to compare our fracture parameters to those mentioned in studies with more specific surgical indications. We also did not have information regarding pre-existing shoulder dysfunction, which could negatively affect ASES scores. Finally, accurate measures of certain social history factors can be difficult to achieve; smoking, alcohol consumption, and alcohol abuse may be subject to underreporting.

CONCLUSION

We assessed parameters that may affect return of shoulder function after scapular fracture. Our results indicate that both 14A and 14B/C fractures have similarly high rates of healing and minimal functional impairment. Patients treated operatively typically had better shoulder functional outcomes. Current or past tobacco use or alcohol abuse was associated with worse functional outcome scores. This could suggest chemical, social, or a combination of these factors affecting muscular recovery and/or greater levels of baseline functional impairment. Finally, concomitant chest wall injuries may not negatively affect shoulder outcome, contrasting with data from previous studies on the more immediate post-injury period.