Clinical and functional outcomes of open reduction and internal fixation for scapular fractures using the modified Judet approach

OBJECTIVE: Displaced scapular fractures are uncommon injuries, and the optimal surgical approach remains controversial. Muscle-preserving techniques may improve post-operative shoulder function by minimizing soft-tissue damage.
The purpose of the study was to evaluate the clinical and functional outcomes of open reduction and internal fixation (ORIF) using a muscle-preserving modified Judet approach in displaced scapular fractures and to assess the effect of surgical timing on post-operative shoulder function.
METHODS: This retrospective study included 12 adult patients who underwent ORIF for displaced scapular fractures between 2015 and 2024 with a minimum follow-up of 12 months. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association system and treated using the modified Judet approach. Functional outcomes were evaluated using the Constant-Murley, Disabilities of the Arm, Shoulder, and Hand (DASH), and University of California, Los Angeles (UCLA) scores, and shoulder range of motion was compared with the contralateral side.
RESULTS: Mean patient age was 35.3±15.0 years, and mean follow-up was 41.6±37.5 months. Fracture union was achieved in all patients at a mean of 7.5±1.7 weeks. No infections, neurovascular injuries, malunion, or infraspinatus atrophy occurred. Final shoulder motion reached 97% forward flexion, 89% abduction, 93% external rotation, and 90.9% internal rotation compared with the contralateral side. Mean constant, DASH, and UCLA scores were 84.0±8.6, 6.1±8.8, and 31.9±3.4, respectively. All patients returned to work at a mean of 4.7±2.3 months.
CONCLUSION: ORIF using a muscle-preserving modified Judet approach provides reliable union, low complication rates, and satisfactory functional recovery in displaced scapular fractures.

Keywords: Modified Judet approach, Open reduction internal fixation, Orthopedic trauma, Scapular fracture, Shoulder function, Surgical timing