Minimally Invasive Fixation of Pathological Fractures of the Shoulder by Percutaneous Osteosynthesis: A Technical Note.

Purpose: Fixation by percutaneous osteosynthesis of the shoulder girdle is rarely performed. We present our experience on percutaneous osteosynthesis of pathological fractures of the shoulder girdle. Materials and Methods: Single institution retrospective study of three patients (mean age 79 years; range 69-89 years) who underwent percutaneous osteosynthesis for four painful pathological fractures of the shoulder girdle between February 2022 and March 2023. All procedures were performed by a senior interventional radiologist under general anesthesia and sterile surgical conditions, with guidance from fluoroscopy and cone-beam computed tomography. All patients were positioned supine. Patient demographics, lesion characteristics, intraprocedural data, associated radiotherapy, and Numerical Rating Score at the time of the procedure and 3 months after the procedure were retrieved. Technical success was defined as accurate screw placement with both ends positioned on either side of the fracture line. Results: Four painful pathological fractures (three acromions and one scapular body) were fixed. Percutaneous osteosynthesis was used alone in two procedures and was combined with tumoral embolization in one procedure. No cement augmentation was used. The mean procedural duration was 85 minutes (range 50-118 minutes), with technical success being 100%. No complication was declared. One patient had radiotherapy one month later. The 3-month Numerical Rating Score was improved in all patients with a mean improvement of 4.3 points (range 2-7). Conclusions: Our series confirms that percutaneous osteosynthesis of the shoulder girdle for pathological fractures is technically feasible and safe, and seems to provide good mid-term outcomes in selected patients. Further studies are warranted to confirm our results.