INTRODUCTION:

Scapular fractures are uncommon and account for approximately 1% of all fractures. They result from high-energy blunt trauma, and 90% of them are associated with various other injuries. Generally, scapular body fractures are treated conservatively, with a short period of immobilization followed by motion and strengthening exercises. However, different problems can be observed in patients with highly displaced fractures.

Reported indications include glenoid neck angulation greater than 40°, fracture displacement of more than 1 cm, a glenopolar angle of less than 20°, and disruption of the superior shoulder suspensory complex. Judet described a posterior approach, which required infraspinatus muscle lateral reflection to expose the infraglenoid fossa and the posterior part of the scapular neck. The limited posterior approach, described by Brodsky, preserves the posterior deltoid and the posterior rotator cuff insertion by developing an interval between the muscular belly of the infraspinatus and the teres minor.

PURPOSE:

This video shows the gross anatomy of the posterior shoulder from skin to bone structures in a cadaver laboratory setting. In addition, the video presents the limited posterior approach for internal fixation of scapular fracture and its results in patients with this injury.

METHODS:

The video presents the gross anatomy of the posterior shoulder in a cadaver laboratory and demonstrates the surgical technique for the fixation of scapular fracture with a limited posterior approach. We retrospectively reviewed the cases of 12 patients who had a scapular neck and body fracture and who underwent surgery with a limited posterior approach to the shoulder for internal fixation. The rehabilitation protocol consisted of the use of a sling for comfort, allowing for progressive passive and active range of motion in the immediate postoperative period. At 6 weeks, patients had full motion, and slow and progressive strengthening began. Outcomes were assessed at a mean follow-up of 24 months (range, 8 to 48 months).

RESULTS:

A total of 12 patients with a mean (SD) age of 37.3 years (7.07 years) (range, 26 to 48 years) were included in the study, and the procedures were performed in the first 3 to 10 days after trauma. There was a reduction of 8 points preoperatively to 1 postoperatively on a visual analog scale, with recovery of the shoulder mobility arc, on average, forward flexion of 155º (range, 140° to 160°), active abduction of 150° (range, 120° to 160°), and external rotation of 41° (range, 12° to 60°). The mean satisfaction of the patients was 8.6 (range, 7 to 10).

CONCLUSION

The limited posterior approach for internal fixation of scapular fracture, respecting the muscular insertions, is a very good option and achieves excellent functional results in patients.