Analysis of operative versus nonoperative treatment of displaced scapular fractures.

BACKGROUND Operative indications for displaced scapular fractures have been controversial and inconsistent. Surgeons have been dissuaded to operate on these uncommon fractures because of the complex anatomy, approaches, and fracture patterns. It is unclear whether return to work, pain, or complications differ in patients with scapular fractures treated nonoperatively or operatively. QUESTIONS/PURPOSES We therefore assessed differences in rates of union, range of motion, ability to return to work, pain, and complications between operatively and nonoperatively treated scapular body and neck fractures. PATIENTS AND METHODS: We retrospectively reviewed 182 patients with 182 scapular fractures treated between 2002 and 2005. Of the 182 fractures, 31 were treated with open reduction internal fixation and matched by age, occupation, and gender to 31 patients treated nonoperatively. The proportions of AO/OTA fracture types were similar in the two groups. The mean displacement, shortening, and angulation were greater in the operative group as compared with the nonoperative group. All patients were followed until healing or discharge from care (average, 1.5 years; range, 14-32 months). We assessed complications, return to work, and radiographic healing. RESULTS All fractures healed. We found no differences in return to work, pain, or complications. CONCLUSIONS Our observations suggest operative treatment of displaced scapula fractures results in similar healing, return to work, pain, and complications as nonoperative treatment. We do not recommend operating on any scapular neck or body fractures displaced less than 20 mm. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.