Surgical approach selection algorithm based on fracture patterns for scapular body fractures

Yuta Izawa; Masahiro Nishida; Kentaro Futamura; Hiroko Murakami; Kazuo Sato; Mizuki Minegishi; Yoshihiko Tsuchida

doi:10.1016/j.jos.2025.09.014

Surgical approach selection algorithm based on fracture patterns for scapular body fractures

J Orthop Sci. 2025 Oct 26:S0949-2658(25)00286-6. doi: 10.1016/j.jos.2025.09.014. Online ahead of print.

Authors

Yuta Izawa¹, Masahiro Nishida², Kentaro Futamura³, Hiroko Murakami⁴, Kazuo Sato⁵, Mizuki Minegishi⁶, Yoshihiko Tsuchida⁷

Affiliations

¹ Department of Trauma Centre, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan; Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan. Electronic address: yutaizawa18@gmail.com.
² Department of Trauma Centre, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan. Electronic address: drmint2001@yahoo.co.jp.
³ Department of Trauma Centre, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan. Electronic address: kenshin@friend.ocn.ne.jp.
⁴ Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan. Electronic address: hmura@pb3.so-net.ne.jp.
⁵ Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan. Electronic address: tetukazu812@gmail.com.
⁶ Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan. Electronic address: mmine.business@gmail.com.
⁷ Department of Trauma Centre, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan; Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan. Electronic address: yoshihiko993711@gmail.com.

PMID: 41145347
DOI: 10.1016/j.jos.2025.09.014

Abstract

Background: Scapular body fractures are uncommon injuries often managed nonoperatively. However, in cases with significant displacement, surgical intervention may be required to restore shoulder function. While various surgical approaches have been described, no standardized method exists for selecting the optimal approach based on fracture morphology. The purpose of this study is to retrospectively evaluate surgical treatment and its outcomes for scapular body fractures, and to validate an appropriate method for selecting surgical approaches according to fracture patterns of the scapular body.

Methods: A retrospective case series was conducted on patients who underwent surgical fixation for scapular body fractures between 2013 and 2024. Fractures involving the glenoid fossa or isolated acromion/coracoid fractures were excluded. Surgical indications included glenopolar angle <22°, coronal angulation >45°, or lateral border offset ≥20 mm. Based on fracture characteristics, four surgical approaches were selected: Brodsky approach, double incision (for medial border translation), modified Judet approach (for scapular spine involvement), and classical Judet approach (for chronic fractures). Postoperative outcomes included radiographic alignment, complications, range of motion (ROM), and pain scores.

Results: Ten patients (mean age 51.3 years) sustained scapular body fractures primarily due to traffic accidents. Surgical approaches included Brodsky approach (n = 6), double incision (n = 2), modified Judet approach (n = 1), and classical Judet approach (n = 1). Postoperative imaging confirmed improved alignment parameters. No infections or nonunions were observed; one clavicle refracture occurred. Final mean ROM showed favorable outcomes in forward flexion, abduction, and external rotation, with low pain scores reported.

Conclusions: We retrospectively evaluated surgical treatment and outcomes in 10 cases of scapular body fractures. All cases achieved satisfactory reduction and functional prognosis, with no serious complications observed. The surgical approach selection method we propose is a rational treatment strategy that optimizes both reduction quality and invasiveness.

Keywords: Brodsky approach; Judet approach; Scapular body fracture; Surgical approach.