Osteosynthesis using a Brodsky approach after scapular fractures: good clinical results after a mean follow-up of 6.3 years

BACKGROUND: This study evaluated the long-term clinical and radiological outcomes of operatively treated scapular fractures using the tissue-sparing posterior Brodsky approach. We hypothesized that osteosynthesis using this approach would yield favorable functional outcomes. METHODS: This retrospective study included patients with acute scapular fractures treated operatively using the posterior Brodsky approach from January 2015 to December 2019. Radiologic evaluation included fracture classification and fracture union. Functional outcomes were assessed using the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Shoulder Pain and Disability Index (SPADI), Visual Analogue Scale (VAS), and range of motion. Postoperative complications were documented. RESULTS: A total of 16 patients with a mean follow-up of 6.3 years were included. The cohort included both extra-articular and intra-articular fracture patterns, with associated injuries such as coracoid fractures. All fractures achieved radiographic union. The mean Constant-Murley Score was 75 ± 14 points, the SPADI score was 85 ± 15, the DASH score was 15 ± 15, and the mean VAS score was 2 ± 1. Shoulder motion was largely preserved, with a mean external rotation of 70° ± 12°. Postoperative complications were observed in one patient due to incorrect screw placement during coracoid fracture fixation. Five patients required a staged surgical procedure due to associated coracoid fractures. CONCLUSIONS: Operative treatment of scapular fractures using a tissue-sparing posterior approach was associated with favorable long-term functional outcomes, preserved shoulder motion, low pain levels, and reliable fracture union, with a low complication rate, even in cases requiring staged procedures due to associated injuries.