Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Scapular spine base fracture with long outside-in superior or posterior screws with reverse shoulder arthroplasty

  • Eroglu, Osman Nuri (Department of Orthopedics and Traumatology, Dokuz Eylul University School of Medicine) ;
  • Husemoglu, Bugra (Department of Biomechanics, Graduate School of Sciences, Dokuz Eylul University) ;
  • Basci, Onur (Department of Orthopedics and Traumatology, Dokuz Eylul University School of Medicine) ;
  • Ozkan, Mustafa (Department of Orthopedics and Traumatology, Dokuz Eylul University School of Medicine) ;
  • Havitcioglu, Hasan (Department of Orthopedics and Traumatology, Dokuz Eylul University School of Medicine) ;
  • Hapa, Onur (Department of Orthopedics and Traumatology, Dokuz Eylul University School of Medicine)
  • Received : 2021.04.06
  • Accepted : 2021.05.01
  • Published : 2021.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model. Methods: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to the study group (spine base fixation with a four long screws, three with both long superior and long posterior screws). Results: The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. Conclusions: The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.

Keywords

References

  1. Crosby LA, Hamilton A, Twiss T. Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res 2011;469:2544-9. https://doi.org/10.1007/s11999-011-1881-3
  2. Neyton L, Erickson J, Ascione F, Bugelli G, Lunini E, Walch G. Grammont Award 2018: scapular fractures in reverse shoulder arthroplasty (Grammont style): prevalence, functional, and radiographic results with minimum 5-year follow-up. J Shoulder Elbow Surg 2019;28:260-7. https://doi.org/10.1016/j.jse.2018.07.004
  3. Stevens CG, Murphy MR, Stevens TD, Bryant TL, Wright TW. Bilateral scapular fractures after reverse shoulder arthroplasties. J Shoulder Elbow Surg 2015;24:e50-5. https://doi.org/10.1016/j.jse.2014.09.045
  4. Hess F, Zettl R, Smolen D, Knoth C. Anatomical reconstruction to treat acromion fractures following reverse shoulder arthroplasty. Int Orthop 2018;42:875-81. https://doi.org/10.1007/s00264-017-3710-0
  5. Ascione F, Kilian CM, Laughlin MS, Bugelli G, Domos P, Neyton L, et al. Increased scapular spine fractures after reverse shoulder arthroplasty with a humeral onlay short stem: an analysis of 485 consecutive cases. J Shoulder Elbow Surg 2018;27:2183-90. https://doi.org/10.1016/j.jse.2018.06.007
  6. Patterson DC, Chi D, Parsons BO, Cagle PJ Jr. Acromial spine fracture after reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2019;28:792-801. https://doi.org/10.1016/j.jse.2018.08.033
  7. Otto RJ, Virani NA, Levy JC, Nigro PT, Cuff DJ, Frankle MA. Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. J Shoulder Elbow Surg 2013;22:1514-21. https://doi.org/10.1016/j.jse.2013.02.007
  8. Kennon JC, Lu C, McGee-Lawrence ME, Crosby LA. Scapula fracture incidence in reverse total shoulder arthroplasty using screws above or below metaglene central cage: clinical and biomechanical outcomes. J Shoulder Elbow Surg 2017;26:1023-30. https://doi.org/10.1016/j.jse.2016.10.018
  9. Kicinski M, Puskas GJ, Zdravkovic V, Jost B. Osteosynthesis of type III acromial fractures with locking compression plate, lateral clavicular plate, and reconstruction plate: a biomechanical analysis of load to failure and strain distribution. J Shoulder Elbow Surg 2018;27:2093-8. https://doi.org/10.1016/j.jse.2018.05.031
  10. DiStefano JG, Park AY, Nguyen TQ, Diederichs G, Buckley JM, Montgomery WH 3rd. Optimal screw placement for base plate fixation in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2011;20:467-76. https://doi.org/10.1016/j.jse.2010.06.001
  11. Mayne IP, Bell SN, Wright W, Coghlan JA. Acromial and scapular spine fractures after reverse total shoulder arthroplasty. Shoulder Elbow 2016;8:90-100. https://doi.org/10.1177/1758573216628783
  12. Molony DC, Cassar Gheiti AJ, Kennedy J, Green C, Schepens A, Mullett HJ. A cadaveric model for suprascapular nerve injury during glenoid component screw insertion in reverse-geometry shoulder arthroplasty. J Shoulder Elbow Surg 2011;20:1323-7. https://doi.org/10.1016/j.jse.2011.02.014
  13. Ahmed M, Young BT, Bledsoe G, Cutuk A, Kaar SG. Biomechanical comparison of long head of biceps tenodesis with interference screw and biceps sling soft tissue techniques. Arthroscopy 2013;29:1157-63. https://doi.org/10.1016/j.arthro.2013.04.001
  14. Arvesen JE, Gill SW, Sinatra PM, Eng M, Bledsoe G, Kaar SG. Biomechanical contribution of tension-reducing rotator cuff sutures in 3-part proximal humerus fractures. J Orthop Trauma 2016;30:e262-6. https://doi.org/10.1097/BOT.0000000000000575
  15. James J, Allison MA, Werner FW, McBride DE, Basu NN, Sutton LG, et al. Reverse shoulder arthroplasty glenoid fixation: is there a benefit in using four instead of two screws. J Shoulder Elbow Surg 2013;22:1030-6. https://doi.org/10.1016/j.jse.2012.11.006
  16. Pastor MF, Kraemer M, Hurschler C, Claassen L, Wellmann M, Smith T. Transfer of the long head of biceps to the conjoint tendon: a biomechanical study. Clin Biomech (Bristol, Avon) 2016;32:80-4. https://doi.org/10.1016/j.clinbiomech.2016.01.004