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Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty : a multicentric retrospective study

Olivier Verstraete, Barbara Van der Mast, Alexander Van Tongel (UGent) , Anne Karelse, Hans Van der Bracht (UGent) , B. Berghs, T. Van Isacker, P. Verniers and Lieven De Wilde (UGent)
(2021) INTERNATIONAL ORTHOPAEDICS. 45(1). p.209-216
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Abstract
Purpose Scapular stress fracture (sSF) is a difficult complication to treat after reverse total shoulder arthroplasty (RSA). The aim of this study was to identify the prevalence and possible risk factors in a large population. Methods A total of 2165 RSAs that were implanted between January 2006 and October 2017 in five hospitals were evaluated. Within this cohort, sSF was radiologically confirmed. Age, gender, surgical indication and hospital of treatment were determined for the entire cohort. A matched 3:1 case-control study was then performed to investigate several clinical and surgical variables. Results sSF occurred in 3.1% (63 patients), with a median time interval of five months post-operative [IQR = 9, range: (1-79)]. Within the entire cohort, females (OR = 2.99) and rotator cuff arthropathy (RCA) (OR = 2.79) were more prone to this complication. Age had little influence (OR = 1.03). After exclusion, fifty-five eligible cases were matched to 165 controls based on hospital, gender, age and surgical indication. After univariable analysis, significance was obtained for osteopenia (P = 0.037), osteoporosis (P = 0.032), surgical approach (P = 0.002) and peri-operative acromioclavicular (AC) joint surgery (P = 0.035). Multivariate analysis demonstrated that osteopenia (OR = 3.94), osteoporosis (OR = 2.85) and a deltopectoral approach (OR = 3.70) were independent risk factors. Conclusion According to our findings, older women with poor bone quality and a history of RCA suffered more frequently from sSF. Anterolateral approach during surgery was a surgical protective factor, possibly due to the mobilization of the acromioclavicular joint. Although this study indicates who is at risk for sSF, further investigation for prevention of sSF in these patients is necessary.
Keywords
Reverse shoulder arthroplasty, Stress fracture, Scapula, Acromion, Risk, factors, Complication

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MLA
Verstraete, Olivier, et al. “Prevalence and Risk Factors of Scapular Stress Fracture after Reverse Shoulder Arthroplasty : A Multicentric Retrospective Study.” INTERNATIONAL ORTHOPAEDICS, vol. 45, no. 1, 2021, pp. 209–16, doi:10.1007/s00264-020-04849-7.
APA
Verstraete, O., Van der Mast, B., Van Tongel, A., Karelse, A., Van der Bracht, H., Berghs, B., … De Wilde, L. (2021). Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty : a multicentric retrospective study. INTERNATIONAL ORTHOPAEDICS, 45(1), 209–216. https://doi.org/10.1007/s00264-020-04849-7
Chicago author-date
Verstraete, Olivier, Barbara Van der Mast, Alexander Van Tongel, Anne Karelse, Hans Van der Bracht, B. Berghs, T. Van Isacker, P. Verniers, and Lieven De Wilde. 2021. “Prevalence and Risk Factors of Scapular Stress Fracture after Reverse Shoulder Arthroplasty : A Multicentric Retrospective Study.” INTERNATIONAL ORTHOPAEDICS 45 (1): 209–16. https://doi.org/10.1007/s00264-020-04849-7.
Chicago author-date (all authors)
Verstraete, Olivier, Barbara Van der Mast, Alexander Van Tongel, Anne Karelse, Hans Van der Bracht, B. Berghs, T. Van Isacker, P. Verniers, and Lieven De Wilde. 2021. “Prevalence and Risk Factors of Scapular Stress Fracture after Reverse Shoulder Arthroplasty : A Multicentric Retrospective Study.” INTERNATIONAL ORTHOPAEDICS 45 (1): 209–216. doi:10.1007/s00264-020-04849-7.
Vancouver
1.
Verstraete O, Van der Mast B, Van Tongel A, Karelse A, Van der Bracht H, Berghs B, et al. Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty : a multicentric retrospective study. INTERNATIONAL ORTHOPAEDICS. 2021;45(1):209–16.
IEEE
[1]
O. Verstraete et al., “Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty : a multicentric retrospective study,” INTERNATIONAL ORTHOPAEDICS, vol. 45, no. 1, pp. 209–216, 2021.
@article{8690547,
  abstract     = {{Purpose Scapular stress fracture (sSF) is a difficult complication to treat after reverse total shoulder arthroplasty (RSA). The aim of this study was to identify the prevalence and possible risk factors in a large population. Methods A total of 2165 RSAs that were implanted between January 2006 and October 2017 in five hospitals were evaluated. Within this cohort, sSF was radiologically confirmed. Age, gender, surgical indication and hospital of treatment were determined for the entire cohort. A matched 3:1 case-control study was then performed to investigate several clinical and surgical variables. Results sSF occurred in 3.1% (63 patients), with a median time interval of five months post-operative [IQR = 9, range: (1-79)]. Within the entire cohort, females (OR = 2.99) and rotator cuff arthropathy (RCA) (OR = 2.79) were more prone to this complication. Age had little influence (OR = 1.03). After exclusion, fifty-five eligible cases were matched to 165 controls based on hospital, gender, age and surgical indication. After univariable analysis, significance was obtained for osteopenia (P = 0.037), osteoporosis (P = 0.032), surgical approach (P = 0.002) and peri-operative acromioclavicular (AC) joint surgery (P = 0.035). Multivariate analysis demonstrated that osteopenia (OR = 3.94), osteoporosis (OR = 2.85) and a deltopectoral approach (OR = 3.70) were independent risk factors. Conclusion According to our findings, older women with poor bone quality and a history of RCA suffered more frequently from sSF. Anterolateral approach during surgery was a surgical protective factor, possibly due to the mobilization of the acromioclavicular joint. Although this study indicates who is at risk for sSF, further investigation for prevention of sSF in these patients is necessary.}},
  author       = {{Verstraete, Olivier and Van der Mast, Barbara and Van Tongel, Alexander and Karelse, Anne and Van der Bracht, Hans and Berghs, B. and Van Isacker, T. and Verniers, P. and De Wilde, Lieven}},
  issn         = {{0341-2695}},
  journal      = {{INTERNATIONAL ORTHOPAEDICS}},
  keywords     = {{Reverse shoulder arthroplasty,Stress fracture,Scapula,Acromion,Risk,factors,Complication}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{209--216}},
  title        = {{Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty : a multicentric retrospective study}},
  url          = {{http://doi.org/10.1007/s00264-020-04849-7}},
  volume       = {{45}},
  year         = {{2021}},
}
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