Extra-articular malunions of the scapula: A comparison of functional outcome before and after reconstruction

Objective: To assess surgical and functional results after corrective reconstruction of malunited, scapula neck or body fractures in patients who presented with chronic pain, limited range of motion, weakness, and gross deformity of the shoulder. Design: Case series. Setting: Level I teaching trauma center. Patients: Between 2000 and 2008, five patients (mean age, 44 years) underwent operative reconstruction of a malunited, scapula neck and/or body fracture. Mean time from injury to surgery was 15 months (range, 8-41 months). All patients presented with debilitating pain and weakness and were unable to return to work. When measured on three-dimensional computed tomographic scan, mean preoperative fracture deformity included 3.0 cm (range, 1.7-4.2 cm) of medial/lateral displacement, 25° (range, 10°-40°) of angular deformity, and a 25° (range, 19°-29°) glenopolar angle. Intervention: Surgical osteotomy and reorientation of scapula neck and/or body, with fixation using 2.7- or 3.5-mm implants and autogenous graft, through a posterior Judet approach. Main Outcomes Measures: Pre- and postoperative functional measures of range of motion and strength testing and patient-based outcome scores (Disabilities of the Arm, Shoulder and Hand and Short Form-36). Results: Mean follow-up was 39 months (range, 18-101 months). All patients united radiographically, were pain-free with regard to the shoulder, and expressed satisfaction with their result. Four of five patients returned to their original occupation and activities. Mean Disabilities of the Arm, Shoulder and Hand score improved from 39 (range, 27-58) preoperatively to 10 (range, 0-35) postoperatively. There were no complications. Conclusions: Malunion after nonoperative treatment of a displaced scapula fracture may be associated with poor functional and cosmetic outcomes. Operative reconstruction can yield good surgical and functional results.