Surgical technique: A minimally invasive approach to scapula neck and body fractures

Background: The approach of choice for open reduction internal fixation of displaced fractures involving the scapula neck or body is from posterior. We describe a new approach that minimizes the surgical insult to the soft tissues but preserves the ability to restore alignment and stability to the fracture. Description of Technique: Based on the fracture pattern, incisions are made along the anatomic bony perimeter to access the scapula borders for reduction and fixation. Since the incisions are centered over sites of "perimeter" fracture displacement of this relatively flat bone, minimal soft tissue retraction and less muscular stripping are necessary, while indirect reduction of the intervening scapula body is accomplished to restore anatomic alignment. Patients and Methods: We retrospectively reviewed seven men with a mean age of 39 years (range, 19-75 years) who underwent open reduction internal fixation of a displaced scapula body or neck fracture using this minimally invasive approach. The minimum followup was 12 months (mean, 16 months; range, 12-23 months). Results: Six of the seven patients returned to their original occupation/activities. The mean Disabilities of the Arm, Shoulder and Hand score at followup was 8.1 (range, 0-52; normative mean, 10.1). For all parameters, the mean SF-36 scores of the study patients were comparable to those of the normal population. Both strength and motion returned to equivalency with the uninjured shoulder. There were no intraoperative or postoperative complications. Conclusions: This novel surgical approach to the scapula allows visualization of fracture reduction without an extensile incision or muscular or subcutaneous flaps and was associated with high functional scores. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.