Work

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

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Scapula fractures are historically managed conservatively. Although surgical treatment has become increasingly common and is associated with favorable outcomes, comparative studies of surgical versus non-surgical 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. Methods MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and the WHO ICTRP 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 non-surgical 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 (UCLA) and Disabilities of the Arm, Shoulder and Hand Score (DASH). A random-effects meta-analysis was performed. Results Twenty-six studies including 601 patients met the inclusion criteria. No statistical difference was observed for scapular neck fractures (p= 0.62; mean CS: surgical 93.6 vs. non-surgical 89.6). In scapular body fractures, Constant Score differences were not significant, while DASH Scores showed a trend favoring surgery (p= 0.05; surgical 5.9 vs. non-surgical 12.8). For floating shoulder injuries, Constant Scores were similar between non-surgical management (77.3) and clavicle fixation alone (76.7), whereas combined scapula-clavicle fixation yielded higher scores (87.0; p=0,14). Conclusion 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.

Source: JSES Reviews Reports and Techniques

DOI: 10.1016/j.xrrt.2026.100666