Comparative study of surgical treatments of scapula fracture through the muscle space of rotator cuff approach and Judet approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TONG Wenqing , HONG Yang , WANG Minghai

Department of Orthopaedics, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, 200240, P. R. China;

Corresponding author：

TONG Wenqing, Email: losary@126.com

Keywords：

Scapula fracture; the muscle space of rotator cuff approach; Judet approach; internal fixation

DOI：

10.7507/1002-1892.201903063

Video：

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Objective To study the surgical treatments of scapula fracture through the muscle space of rotator cuff approach and the Judet approach, and to evaluate and compare the clinical results.Methods Between January 2014 and December 2015, 50 patients with scapula fractures were treated with open reduction and internal fixation of reconstruction plate. Twenty-four patients were treated through the muscle space of rotator cuff approach (group A), and 26 patients were treated through the Judet approach (group B). There was no significant difference in gender, age, cause of injury, type of fracture, and the interval between injury and operation (P>0.05). The operation time, intraoperative blood loss, and incision length were recorded, and the shoulder functions after fracture healing confirmed by X-ray films were evaluated according to the Hardegger’s scoring system.Results The operation time, intraoperative blood loss, and incision length in group A were significantly lower than those in group B (P < 0.05). The incisions of the two groups healed by first intention. All patients were followed up 6-13 months (mean, 11.6 months) in group A and 7-15 months (mean, 12.1 months) in group B. According to Hardegger standard, the effectiveness was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case, with the excellent and good rate of 95.8% in group A, and as excellent in 15 cases, good in 4 cases, fair in 5 cases, and poor in 2 cases with the excellent and good rate of 73.1% in group B. The difference in effectiveness between 2 groups was significant (χ²=4.81, P=0.03). X-ray films showed that the reduction and internal fixation were satisfied and the fractures healed in 2 groups. The fracture healing time were (29.86±8.38) weeks in group A and (30.05±7.99) weeks in group B, showing no significant difference between 2 groups (t=0.16, P=0.87). Conclusion Compared with the Judet approach, the muscle space of rotator cuff approach has advantages of clearly exposure, less muscular dissection, less intraoperative blood loss, less operation time, easier operation, and satisfied shoulder function can be obtained.

Citation： TONG Wenqing, HONG Yang, WANG Minghai. Comparative study of surgical treatments of scapula fracture through the muscle space of rotator cuff approach and Judet approach. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1389-1393. doi: 10.7507/1002-1892.201903063 Copy

1.	Tuček M, Chochola A, Klika D, et al. Epidemiology of scapular fractures. Acta Orthop Belg, 2017, 83(1): 8-15.
2.	Neral M, Knapik DM, Wetzel RJ, et al. Scapular body fracture in the athlete: A systematic review. HSS J, 2018, 14(3): 328-332.
3.	Tadros AM, Lunsjo K, Czechowski J, et al. Causes of delayed diagnosis of scapular fractures. Injury, 2008, 39(3): 314-318.
4.	Surace PA, Boyd AJ, Vallier HA. Case series evaluating the operative and nonoperative treatment of scapular fractures. Am J Orthop (Belle Mead NJ), 2018, 47(8): 1-11.
5.	Cole PA Jr, Gilbertson JA, Cole PA Sr. Functional outcomes of operative management of scapula fractures in a geriatric cohort. J Orthop Trauma, 2017, 31(1): e1-e8.
6.	Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures. Rozhl Chir, 2018, 97(2): 67-76.
7.	Cole PA, Dugarte AJ. Posterior scapula approaches: extensile and modified Judet. J Orthop Trauma, 2018, 32(Suppl 1): S10-S11.
8.	Manohara R, Kumar VP. A reverse Judet approach to the scapula. Arch Orthop Trauma Surg, 2018, 138(5): 669-673.
9.	Noguchi T, Mautner JF, Duncan SFM. Dorsal plate fixation of scapular fracture. J Hand Surg (Am), 2017, 42(10): 843.e1-843.e5.
10.	Ao R, Yu B, Zhu Y, et al. Single lateral versus medial and lateral plates for treating displaced scapular body fractures: a retrospective comparative study. J Shoulder Elbow Surg, 2018, 27(2): 231-236.
11.	Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fracture. J Bone Joint Surg (Br), 1984, 66(5): 725-731.
12.	Schroder LK, Gauger EM, Gilbertson JA, et al. Functional outcomes after operative management of extra-articular glenoid neck and scapular body fractures. J Bone Joint Surg (Am), 2016, 98(19): 1623-1630.
13.	Fandridis E, Anastasopoulos PP, Alexiadis G, et al. Posterior subdeltoid and external rotators preserving approach for reduction and fixation of displaced extra-articular fractures of the scapula. Eur J Orthop Surg Traumatol, 2018, 28(4): 585-591.
14.	Labronici PJ, Tavares AK, Canhoto EC, et al. Does the position of the scapula in relation to the glenopolar angle change the preferred treatment of extra-articular fractures? Injury, 2017, 48(Suppl 4): S21-S26.
15.	Dugarte AJ, Tkany L, Schroder LK, et al. Comparison of 2 versus 3 dimensional fracture mapping strategies for 3 dimensional computerized tomography reconstructions of scapula neck and body fractures. J Orthop Res, 2018, 36(1): 265-271.
16.	Suter T, Henninger HB, Zhang Y, et al. Comparison of measurements of the glenopolar angle in 3D CT reconstructions of the scapula and 2D plain radiographic views. Bone Joint J, 2016, 98-B(11): 1510-1516.
17.	Kejriwal R, Ahuja T, Hong T. Is radiograph glenopolar angle accurate for extraarticular scapular neck fractures? Injury, 2016, 47(12): 2772-2776.
18.	Chang AC, Phadnis J, Eardley-Harris N, et al. Inferior angle of scapula fractures: a review of literature and evidence-based treatment guidelines. J Shoulder Elbow Surg, 2016, 25(7): 1170-1174.
19.	Zahid M, Rashid EH, Inam H, et al. Outcomes of open reduction and internal fixation in displaced intra-articular scapular fractures: a case series. Acta Orthop Belg, 2017, 83(1): 16-21.

1. Tuček M, Chochola A, Klika D, et al. Epidemiology of scapular fractures. Acta Orthop Belg, 2017, 83(1): 8-15.
2. Neral M, Knapik DM, Wetzel RJ, et al. Scapular body fracture in the athlete: A systematic review. HSS J, 2018, 14(3): 328-332.
3. Tadros AM, Lunsjo K, Czechowski J, et al. Causes of delayed diagnosis of scapular fractures. Injury, 2008, 39(3): 314-318.
4. Surace PA, Boyd AJ, Vallier HA. Case series evaluating the operative and nonoperative treatment of scapular fractures. Am J Orthop (Belle Mead NJ), 2018, 47(8): 1-11.
5. Cole PA Jr, Gilbertson JA, Cole PA Sr. Functional outcomes of operative management of scapula fractures in a geriatric cohort. J Orthop Trauma, 2017, 31(1): e1-e8.
6. Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures. Rozhl Chir, 2018, 97(2): 67-76.
7. Cole PA, Dugarte AJ. Posterior scapula approaches: extensile and modified Judet. J Orthop Trauma, 2018, 32(Suppl 1): S10-S11.
8. Manohara R, Kumar VP. A reverse Judet approach to the scapula. Arch Orthop Trauma Surg, 2018, 138(5): 669-673.
9. Noguchi T, Mautner JF, Duncan SFM. Dorsal plate fixation of scapular fracture. J Hand Surg (Am), 2017, 42(10): 843.e1-843.e5.
10. Ao R, Yu B, Zhu Y, et al. Single lateral versus medial and lateral plates for treating displaced scapular body fractures: a retrospective comparative study. J Shoulder Elbow Surg, 2018, 27(2): 231-236.
11. Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fracture. J Bone Joint Surg (Br), 1984, 66(5): 725-731.
12. Schroder LK, Gauger EM, Gilbertson JA, et al. Functional outcomes after operative management of extra-articular glenoid neck and scapular body fractures. J Bone Joint Surg (Am), 2016, 98(19): 1623-1630.
13. Fandridis E, Anastasopoulos PP, Alexiadis G, et al. Posterior subdeltoid and external rotators preserving approach for reduction and fixation of displaced extra-articular fractures of the scapula. Eur J Orthop Surg Traumatol, 2018, 28(4): 585-591.
14. Labronici PJ, Tavares AK, Canhoto EC, et al. Does the position of the scapula in relation to the glenopolar angle change the preferred treatment of extra-articular fractures? Injury, 2017, 48(Suppl 4): S21-S26.
15. Dugarte AJ, Tkany L, Schroder LK, et al. Comparison of 2 versus 3 dimensional fracture mapping strategies for 3 dimensional computerized tomography reconstructions of scapula neck and body fractures. J Orthop Res, 2018, 36(1): 265-271.
16. Suter T, Henninger HB, Zhang Y, et al. Comparison of measurements of the glenopolar angle in 3D CT reconstructions of the scapula and 2D plain radiographic views. Bone Joint J, 2016, 98-B(11): 1510-1516.
17. Kejriwal R, Ahuja T, Hong T. Is radiograph glenopolar angle accurate for extraarticular scapular neck fractures? Injury, 2016, 47(12): 2772-2776.
18. Chang AC, Phadnis J, Eardley-Harris N, et al. Inferior angle of scapula fractures: a review of literature and evidence-based treatment guidelines. J Shoulder Elbow Surg, 2016, 25(7): 1170-1174.
19. Zahid M, Rashid EH, Inam H, et al. Outcomes of open reduction and internal fixation in displaced intra-articular scapular fractures: a case series. Acta Orthop Belg, 2017, 83(1): 16-21.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study of surgical treatments of scapula fracture through the muscle space of rotator cuff approach and Judet approach

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