Surgical treatment of complex scapular fractures: a single centre prospective observational study

Abstract Background Conservative management is traditionally preferred for scapular fractures, but recent studies suggest that surgical intervention may improve outcomes in selected patients. This study evaluates functional and imaging outcomes, complication rates, and under-reported factors, such as duration of surgery and time from injury to definitive fixation, in surgically treated patients. Methods This prospective observational study included 12 patients who underwent surgery for scapular fractures between 2016 and 2022. Inclusion criteria were complex scapular fractures, defined as displaced fractures with articular extension or floating shoulder (i.e., with associated ipsilateral clavicle fractures), and good psychophysical condition for postoperative evaluation. Exclusion criteria included isolated intra-articular glenoid fractures, associated proximal humerus fractures, and patients who did not complete the 1-year follow-up. Functional outcomes were assessed using the Quick-DASH, Constant-Murley Score, and Simple Shoulder Test, with imaging outcomes evaluated through follow-up imaging. Statistical analysis included t-test and linear regression. Results The mean age at the time of injury was 48.3 ± 15.9 years. At one year, the Quick-DASH score was 13.6 ± 10.5%, the Constant-Murley Score improved to 87.9 ± 5.3, and the Simple Shoulder Test increased to 11.7 ± 0.50. Range of motion improved significantly across all parameters, especially between 6 and 12 months ( p < 0.05), without statistically significant differences compared with the contralateral side at 1 year. A significant association between age and external rotation values was evident at six months. Conclusion Open reduction and internal fixation (ORIF) of complex scapular fractures yield excellent functional recovery and high patient satisfaction. Accurate fracture classification and tailored surgical approaches optimise outcomes. These findings support the role of ORIF and emphasise the importance of the trauma-to-surgery interval and operative time.