# Surgical vs. nonsurgical treatment of extra-articular scapula fractures: a systematic review and meta-analysis

## TL;DR

This study compares surgical and nonsurgical treatments for scapula fractures and finds no significant overall benefit from surgery, though some cases show potential improvement.

## Contribution

This is the first systematic meta-analysis comparing surgical and nonsurgical outcomes for extra-articular scapula fractures by fracture localization.

## Key findings

- Surgical and nonsurgical treatments for scapular neck fractures showed no significant difference in outcomes.
- Floating shoulder injuries treated with combined scapula–clavicle fixation showed higher Constant Scores compared to other methods.
- Current evidence is limited by heterogeneity, emphasizing the need for high-quality prospective studies.

## Abstract

Scapula fractures are historically managed conservatively. Although surgical treatment has become increasingly common and is associated with favorable outcomes, comparative studies of surgical vs. nonsurgical management remain scarce. To the best of our knowledge, this meta-analysis is the first systematic comparison of outcomes in extra-articular scapula fractures according to fracture localization.

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform were systematically searched in April 2024 for studies on extra-articular scapula fractures. Two reviewers independently conducted a two-stage screening process. Patients were grouped into scapular neck, scapular body, and floating shoulder fractures, each stratified by surgical or nonsurgical management. Surgically treated floating shoulder injuries were further categorized by clavicle fixation alone or combined scapula–clavicle fixation. Outcomes included the Constant Score (CS), University of California Los Angeles Shoulder score, and Disabilities of the Arm, Shoulder, and Hand score. A random-effects meta-analysis was performed.

Twenty-six studies including 601 patients met the inclusion criteria. No statistical difference was observed for scapular neck fractures (P = .62; mean CS: surgical 93.6 vs. nonsurgical 89.6). In scapular body fractures, CS differences were not significant, while Disabilities of the Arm, Shoulder, and Hand scores showed a trend favoring surgery (P = .05; surgical 5.9 vs. nonsurgical 12.8). For floating shoulder injuries, CSs were similar between nonsurgical management (77.3) and clavicle fixation alone (76.7), whereas combined scapula–clavicle fixation yielded higher scores (87.0; P = .14).

Surgical intervention for extra-articular scapular fractures showed no significant overall benefit, though floating shoulder injuries trended toward clinically meaningful improvement. Current evidence is limited by heterogeneity, highlighting the need for high-quality prospective studies to guide optimal management.