JBJS - 2026-09-23 - Journal Article
Extra-Articular Malunions and Nonunions of the Scapular Body and Neck: A Comparison of Functional Outcomes Before and After Reconstruction.
Cole PA, Xu JL, Huaco AA, LaRoque MC, Winter JD
Topics
Key Takeaway
Surgical reconstruction of scapular neck and body malunions and nonunions produced a mean 30.7-point improvement in DASH score (p<0.001), with 100% radiographic union and no intraoperative complications in 45 patients.
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Summary
This retrospective case series evaluated functional outcomes before and after surgical reconstruction of symptomatic extra-articular scapular neck and body malunions (n=40) and nonunions (n=5) at a single Level-1 trauma center over 21 years. Osteotomy with deformity correction was performed at a median of 10 months post-injury; all 45 patients achieved radiographic union with no intraoperative complications. Mean DASH improved 30.7 points (final mean 14.1 for early reconstruction vs. 23.2 for late), forward flexion and abduction improved significantly in both ROM and strength, but external rotation ROM and strength showed no significant improvement.
Key Limitation
The absence of a nonoperative comparator group makes it impossible to attribute functional gains solely to surgery rather than to natural recovery over the median 10-month interval from injury to reconstruction.
Original Abstract
BACKGROUND
Malunions and nonunions of scapular neck and body fractures can cause considerable pain and disability. This study reports outcomes regarding functional measures, range of motion, and strength before and after reconstruction.
METHODS
This retrospective case series at a Level-1 trauma center between 2003 and 2024 identified 50 consecutive patients (mean age, 50.3 years; 82% male; 80% White) with symptomatic malunion or nonunion of a scapular neck and/or body fracture who were referred to a single surgeon. Medial-lateral displacement and angular deformity were corrected through surgical reconstruction and malunion osteotomy. The Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion, strength, and postoperative procedures requiring a return to the operating room were recorded.
RESULTS
Fifty patients were included in the study; 5 patients were lost to follow-up before 12 months, leaving 45 patients (40 with malunion and 5 with nonunion) with >1-year outcomes. Eleven patients underwent reconstruction between 6 weeks and 3 months after injury because of the severity of the injury, their symptoms, and/or the necessity of an osteotomy. The median time from injury to reconstruction was 10 months (interquartile range [IQR] width, 16 months), and the median follow-up was 28.9 months (IQR width, 23.2 months). All patients achieved radiographic evidence of union. No intraoperative complications occurred. There was a mean 30.7-point improvement between the preoperative and final postoperative DASH scores (p < 0.001). The mean postoperative DASH score was 14.1 in patients who underwent reconstruction between 6 weeks and 3 months and was 23.2 in those who underwent reconstruction after 3 months. Forward flexion and abduction demonstrated significant increases in both range of motion and strength from preoperatively to postoperatively. External rotation range of motion and strength showed no significant increases. Subsequent procedures were performed in 12 patients: 8 patients underwent symptomatic implant removal (1 also underwent concurrent manipulation under anesthesia), 1 patient underwent open reduction and internal fixation for a new fracture, 2 patients underwent implant revision (1 also underwent concurrent manipulation under anesthesia), and 1 patient underwent manipulation under anesthesia for shoulder contracture.
CONCLUSIONS
Extra-articular scapular malunions and nonunions can be associated with considerable pain and disability. Deformity correction improved range of motion and strength and reduced disability in this cohort. A principled reconstruction can be successful in addressing the sequelae of displaced scapular fractures.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.