Executive Editor: Joseph Schatzker General Editor: Jonas Andermahr, Michael McKee, Diane Nam

Scapula 14.1 B1.1 Partial articular, anterior simple - lag screw fixation

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Glossary

1 Principles/Introduction top

Main goal

In this procedure the main goal is to reconstruct the joint surface.


Screw selection enlarge

Screw selection

For this procedure the following screws are typically used:

  • Conventional 3.5 lag screws
  • Cannulated 3.5 lag screws
  • Headless 3.0 screws

Headless screws are preferable where fixation involves inserting them through capsule or labrum. 

If a headless screw is used, bicortical purchase is preferred but not required for compression.

2 Approach top

Approach enlarge

Anterior fractures are reduced and fixed through the delto-pectoral approach.

3 Reduction top

Reduction enlarge

Reduction of the articular surface may be facilitated by the insertion of a K-wire to be used as joystick. For this reason we prefer to use the cannulated system and insert the K-wire in such a way that it will subsequently serve as a guide for the lag screw trajectory.

Whenever K-wires are used as joysticks, whether as subsequent guide wires or not, they should not be inserted trans articulary.


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When conventional screws are used for the fixation, care has to be taken that the K-wire does not interfere with the planned screw placement.


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When reduction is completed, the K-wire is further inserted to temporarily fix the fracture.

Make sure that K-wires are not directed into the suprascapular notch where they can compromise the neurovascular bundle.


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Depending on the size of the fragment, two lag screws are preferred since one does not offer rotational stability.


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The K-wires are removed.


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Check the position of the screws and the reduction by image intensification in the standard projections (trans-glenoid and trans scapular view). A 3D-CT scan, if available, is very useful to verify the position of the fixation devices.

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