Long-term results of surgical management of high-energy scapula fractures at a major trauma center

Background

Scapular fractures are rare injuries typically resulting from high-energy trauma and often occur in polytrauma patients. Historically managed nonoperatively, recent trends in surgical intervention have evolved, particularly in major trauma centers (MTCs) where expertise and case volume have increased. However, there remains limited literature on the surgical management and long-term outcomes of these injuries.

Methods

This retrospective cohort study reviewed all patients who underwent surgical fixation for scapular fractures over a 10-year period at a single UK MTC. Patient demographics, injury mechanism, fracture classification (using the Swedish Fracture Registry topographical system), surgical approach, and outcomes were analyzed. Outcomes included objective measures (union, complications, return to work/sport) and patient-reported outcome measures (Oxford Shoulder Score, disability of the arm, shoulder, and hand, American Shoulder and Elbow Surgeons score, EuroQol 5-Dimension questionnaire, and EuroQol Visual Analogue Scale). Statistical analysis included chi-squared and Mann-Whitney-Wilcoxon tests.

Results

Forty-five patients (36 males; mean age 46 years) were included. The majority (64%) sustained injuries from road traffic accidents, with 49% classified as having severe or profound injuries (injure severity score >15). Displaced intra-articular fractures represented the most common fracture subtype (53%). At a mean follow-up of 78 months, 56% of patients completed patient-reported outcome measures. Mean scores were Oxford Shoulder Score: 40.1, disability of the arm, shoulder, and hand: 15.3, American Shoulder and Elbow Surgeons score: 82.7, EuroQol 5-Dimension questionnaire: 0.54, and EuroQol Visual Analogue Scale: 82.1. Intra-articular fractures were associated with the highest complication and reoperation rates, primarily due to post-traumatic glenohumeral capsulitis and early arthrosis. The overall complication rate was 35.7%, reducing to 15.6% when excluding capsulitis. No 30-day mortality was observed. Return to work and sport occurred at a mean of 147 and 185 days, respectively.

Conclusion

Surgical management of high-energy scapular fractures in a high-volume MTC setting can achieve good long-term clinical outcomes. Intra-articular fracture patterns carry a higher risk of complications and may require further intervention. This study provides the longest reported follow-up of scapula fracture surgery to date and highlights the importance of specialist surgical experience, structured classification, and long-term patient support.