Scapular body fractures—should we be fixing more of these?

Abstract

The question of whether we should be fixing more scapular body fractures originates from the historical preference for nonoperative management of these fractures. Recently, there has been a renewed interest in operative management due to the recognition that scapular malunion can cause significant disability. While the treatment pendulum has shifted away from benign neglect, finding the right balance of surgical aggression remains controversial. In general, the majority of scapula fractures can successfully be treated nonoperatively with excellent functional results. However, numerous case studies exist demonstrating poor outcomes of scapular body or neck fractures with increased deformity. The literature suggests that a glenopolar angle (GPA) less than 20 degrees can lead to a significant decrease in shoulder function. Additionally, retrospective studies using lateral border offset (LBO) greater than >2 cm and angulation >45 degrees as a surgical indication demonstrate functional outcomes with near normal strength and range of motion and low complication rates. While numerous cut-offs for surgical indications have been recommended, all indications are considered relative and treatment should be individualized based on patient characteristics and goals.