Predictors of functional outcome after extra-articular scapular fracture stabilization with Brodsky approach

TL;DR

This study examines factors affecting recovery after surgery for scapular fractures using the Brodsky approach.

Contribution

Identifies the contralateral shoulder's preoperative function as the best predictor of postoperative recovery.

Findings

Patients achieved full fracture union with no complications.

The contralateral Constant score was the only independent predictor of postoperative outcome.

Radiographic improvements did not predict functional outcomes.

Abstract

Although surgical stabilization for displaced extra-articular scapular fractures is increasingly utilized, there remains limited evidence on predictors of functional recovery. This study aimed to evaluate long-term functional and radiographic outcomes after stabilization using the Brodsky posterior approach and to determine whether glenopolar angle or lateral border medialization independently predicts postoperative function. We hypothesized that improved radiographic parameters would be associated with better outcomes.

This retrospective cohort included 16 patients with displaced extra-articular scapular fractures treated with open reduction and internal fixation via the Brodsky approach. Functional recovery was assessed using the Constant score at 48 months postoperatively. Pre- and postoperative glenopolar angle and lateral border medialization were measured. Paired comparisons and multiple linear regression were used to identify predictors of outcome.

All patients achieved full fracture union without complications or need for reoperation. The median Constant score of the operated shoulder was 94 (IQR 88–95), compared to 96 (IQR 93–96) in the contralateral shoulder (p = 0.002). Despite statistical significance, the 2-point difference did not exceed the minimal clinically important difference for shoulder function. Postoperative improvements in glenopolar angle and medialization were significant. The contralateral Constant score was the only independent predictor of postoperative outcome (β = 1.52, p = 0.001). Radiographic variables were not predictive.

The Brodsky approach yields excellent long-term outcomes. Although radiographic correction is achieved, the preoperative function of the contralateral shoulder remains the most reliable indicator of postoperative recovery potential.

The online version contains supplementary material available at 10.1007/s00590-025-04355-9.

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