Scapula insufficiency fractures after reverse total shoulder arthroplasty in rotator cuff arthropathy: What is their functional impact?

Introduction-objectives To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy. Material and method A retrospective study was conducted on 126 RSA between 2009 and 2011, in which four fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D). Results The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P > .05); postoperative Constant score: 81.2 and 66.5%, respectively (P > .001). Forward elevation and abduction in fracture patients decreased by 39° (P = .02), and 34° (P = .057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P = .002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months. Conclusions Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication.