ABSTRACT
We report an 89-year-old woman with bilateral atraumatic scapular spine fracture several months after bilateral reverse total shoulder arthroplasty (RTSA). Recently, RTSA has gained popularity in the surgical treatment of complex shoulder disorders such as cuff tear arthropathy. However, scapular fractures may occur several months after surgery as a late complication of this procedure. In this case report we focus on a relatively uncommon subtype, the scapular spine fracture. Although well-known in the orthopedic literature, radiologists are less familiar with this complication. To the best of our knowledge, bilateral scapular fractures have not yet been reported.
Subject(s)
Arthroplasty, Replacement/adverse effects , Fractures, Bone/diagnosis , Fractures, Bone/etiology , Scapula/injuries , Shoulder Joint/surgery , Shoulder Pain/etiology , Aged, 80 and over , Female , Fractures, Bone/rehabilitation , Humans , Radiography , Radionuclide Imaging , Scapula/diagnostic imaging , Shoulder Joint/diagnostic imaging , Shoulder Pain/diagnosisABSTRACT
The reverse shoulder prosthesis reverses the relationship between the scapular and humeral component, resulting in a mechanical advantage as the deltoid muscle is able to compensate for the rotator cuff deficiency. Based on this mechanical advantage, the reverse shoulder prosthesis has become an accepted alternative for the treatment of complex proximal humeral fractures. The purpose of this article is to discuss technical considerations related to stability in the use of the reverse shoulder prosthesis in acute shoulder fractures, based on clinical experience.
Subject(s)
Joint Prosthesis , Shoulder Fractures/surgery , Humans , Joint Instability/prevention & control , Prosthesis DesignABSTRACT
A total of forty consecutive patients suffering from recurrent traumatic anterior shoulder instability underwent stabilisation with a glenoid based inferior capsular shift. The patients were followed up prospectively by an independent observer (JM) using the Constant-Murley score and objective evaluation of shoulder movement and strength with an isometric dynamometer. The mean follow-up period was 50 months (range, 2 to 6.8 years). Three patients (7.5%) suffered a repeat, high energy, traumatic dislocation following an early return to sports activities. "Cybex" testing documented a minimal average loss of external rotation movement (4.4 degrees) and strength (4.3%) with the arm in neutral, which was higher with the arm at 90 degrees of abduction (i.e., 13.7 degrees and 15.6%, respectively). The deficit in internal rotation strength was similarly lower in neutral position (2%), when compared to the deficit with the arm at 90 degrees of abduction (13.5%). There was no measurable loss of internal rotation motion. Our study supports the use of a glenoid based inferior capsular shift, as there is a low recurrence rate and minimal deficit in shoulder movement and strength.
