Table 4.
Comparison of posterior approaches reported in the literature
| Study | Fracture types amenable to fixation | Incision | SubQ flap | Infraspinatus flap | Deltoid reflection or split | Clinical experience | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Body | Neck | Posterior glenoid | Patients (% followup) | Mean followup | Outcome measurements/comments | |||||
| Hardegger et al. [8] (1984) | No | Yes | Yes | Starts at acromion and extends medially along scapular spine curving to inferior scapula angle | Yes | Optional | NR | 37 (89%) | 6.5 years (18 months to 15 years) | ROM: 21 full; pain: 25 pain free; strength grade: 22 patients 5/5; unclear what % patients underwent posterior approach |
| Norwood et al. [24] (1985) | No | No | Yes | Starts midscapular spine curving anteriorly at posterior edge of acromion | No | No | Yes | 42 (100%) | NR | No infection; no deltoid weakness; good strength; only 1 patient had a scapula fracture |
| Wirth et al. [32] (1993) | No | Yes | Yes | 8-cm straight incision from lateral acromion to posterior axillary crease | Yes | No | Yes | 35 (86%) | 20 months (1 month to 11.4 years) | No weakness; only 1 patient had a scapula fracture |
| Ebraheim et al. [7] (1997) | No | Yes | Yes | Starts at medial 1/3 scapular spine and extends laterally curving distally along lateral border | Yes | Optional | Yes | 2 (100%) | NR | No complications; neurovascularly intact |
| Jerosch et al. [15] (2001) | No | Yes | Yes | Oblique incision immediately inferior and in line with deltoid fibers | No | No | No | 12 (100%) | NR | No complications; no signs/symptoms of sensory or motor dysfunction; no patients were treated for a scapula fracture |
| Obremskey and Lyman [25] (2004) | Yes | Yes | Yes | Starts inferiorly to the acromion and extends medially to the superomedial angle, curving inferiorly to inferior angle | Yes | No | Yes | 10 (NR) | NR | No complications; 100% union; nearly full ROM and strength |
| Wiedemann [30] (2004) | No | Yes | Yes | Oblique incision starting slightly inferior to the medial 1/3 of the scapular spine and extending laterally into the axilla | No | No | No | None | NA | NA |
| Braun et al. [4] (2005) | No | Yes | Yes | Starts at acromion and extends medially along scapular spine curving to inferior scapula angle | Yes | No | Yes | 19 (100%) | 26 months (6–39 months) | Constant-Murley score: 79.9/100 |
| Nork et al. [23] (2008) | Yes | Yes | Yes | Starts inferiorly to the acromion and extends medially to the superomedial angle, curving inferiorly to inferior angle | Yes | No | Yes | 17 (100%) | NR | No postoperative neurologic deficits; no wound infections; 100% union |
| Gauger and Cole (2011) | Yes | Yes | Yes | ~6-cm incisions along the scapula bony perimeter to access fracture exit sites | No | No | No | 7 (100%) | 16 months (12–23 months) | Clinical: ROM, strength, return to work/activities; functional: DASH, SF-36 |
SubQ = subcutaneous; NR = not reported; NA = not applicable.