Objective: The reverse Judet approach is a modified technique for scapular fractures, designed to reduce tissue damage and minimize surgical morbidity. However, its comparative efficacy and safety relative to the modified Judet approach have not been well established. Therefore, this study aimed to (1) evaluation of the safety and feasibility of reverse Judet approach for scapular fractures and (2) comparing the advantages and disadvantages of reverse Judet and modified Judet approaches in perioperative indicators and postoperative functional recovery.
Methods: A retrospective analysis was conducted on 40 patients with extra-articular glenoid neck or scapular body fractures admitted between July 2021 and September 2023. The cohort comprised 18 cases in the reverse Judet group and 22 cases in the modified Judet group. Baseline data, surgical parameters (incision length, flap area, operative time, intraoperative blood loss), functional outcomes (DASH score, Constant–Murley score), and complications were recorded.
Results: There were no significant differences in baseline characteristics between the two groups. The reverse Judet group showed significantly better outcomes compared to the modified Judet group in terms of incision length (15.2 ± 1.3 vs. 20.1 ± 1.0 cm, p < 0.001) and flap area (49.5 ± 6.2 cm2 vs. 67.4 ± 4.7 cm2, p < 0.001). Although not statistically significant, the reverse Judet group tended to have shorter operative times (100.2 ± 20.1 113.4 ± 21.2 min, p = 0.053) and less intraoperative blood loss (136.7 ± 36.0 vs. 155.2 ± 26.9 mL, p = 0.051). Functional assessments showed no significant differences in DASH scores (7.8 ± 2.7 vs. 9.5 ± 4.1, p = 0.156) or Constant–Murley scores (84.3 ± 5.4 vs. 84.1 ± 4.6, p = 0.929) between groups. Neither group experienced nonunion, implant-related complications, or neurovascular injury.
Conclusion: The reverse Judet approach offers benefits such as smaller incisions and less tissue damage while providing adequate exposure for fracture reduction and fixation. Functional recovery is similar to that of the modified Judet approach. Its minimally invasive nature and better esthetic results make it a more comprehensive surgical option for posterior shoulder issues. Although this study did not find an increased risk of flap complications, larger studies are necessary to further improve flap design.
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