Mini-boomerang Approach for the Treatment of Specific Laterally-based Fracture Patterns of the Glenoid and Scapular Neck

Background: Several posterior approaches have been developed for scapula neck and body fractures undergoing operative management, with variations balancing priorities of visualization and minimization of soft tissue disruption. Seldom, consideration is given to adjusting the surgical approach based on specific and known fracture patterns. The purpose of this manuscript is to describe the mini-boomerang surgical technique for surgeons encountering a subtype of less common fracture patterns and report clinical outcomes for 7 patients after surgical treatment with this approach. Methods: For a subtype of laterally-based scapula fractures isolated to the scapular anatomic neck ± glenoid, and/or crossing the scapular spine, we describe and illustrate the mini-boomerang, a variation on the classic Judet incision. This cohort included 4 men and 3 women with a mean age of 39 years (range = 23 to 57). Postoperatively, all patient scores for disabilities of shoulder and hand (DASH), along with a range of motion and strength measurements for the injured and contralateral shoulder, were collected. Results: Seven patients underwent mini-boomerang incision for scapula fractures. Five patients achieved follow-up of 12 months or greater (mean= 24; range=14 to 31 months). The mean ROM for the injured versus uninjured shoulder at final follow-up was 99% for forward flexion (FF), 98% for abduction (ABD), and 75% for external rotation (ER). The mean postoperative strength of the injured versus uninjured shoulder at final follow-up was 81% for FF, 92% for ABD, and 70% for ER. Conclusion: The mini-boomerang approach decreases soft tissue exposure while enhancing visualization for fracture reduction and fixation.