Objective To explore the effective method for treatmentof fracturesof scapular neck.Methods A retrospective analysis of 30 patients with fractures of scapular neck was done. The patients were treated by operation or by nonoperation from May 1994 to May 2003. According to the degree of displacement,30 cases included 9 mild displaced fractures(lt;10 mm) and 21 severe displaced fractures(gt;10 mm). According to the location of fractures, there were 24 cases of surgical neck fractures and 6 cases of anatomical neck fractures. Of all 30 patients, 12 were treated by nonoperation and 18 by operation. All fractured scapularnecks were exposed through posterior approach and fixed with interfragmentary compression screws, reconstruction plates and so on after satisfactory reduction.Associated clavical fractures were exposed through Langer’s approach and fixed with Kirschner wire-tension band fixation construct, reconstruction plates and so forth. When followed up, the clinical examination was done and the X-ray filmswere taken to measure glenopolar angle(GPA). Herscovici’s score was adopted.Results Twenty-eight patients were followed up from 14 days to 9 years. Among 11 patients treated by non-operation, Herscivici score showed that 4 cases achieved the excellent result, 2 cases good, 2 cases fair and 3 cases poor and the X-ray film results showed that there were 6 cases of GPA＞20° and 5 cases of GPA＜20°. Of 17 patients treatedby operation, Herscivici score showed that 11 cases achieved the excellent result, 5 cases good and 1 case fair and the X-ray film results showed that there 16 cases of GPA＞20° and 1 case of GPA＜20°.Conclusion Fractures of scapular surgical neck with mild displacement can be treated by nonoperation, while fractures of surgical neck with severe displacement or associated with ipsilateral clavical fractures, and fractures of anatomical neck should be treated by operation to reconstruct the stabilityof shoulder and minimize the complications.
Fifty cases of adult cadaveric subscapular arteries and its circumflex scapulae branches and from 102 of adult skelet on the axillary border of scapulae were measured. The results were that: the external diameter of the subscapular artery was 4.3cm with the length of 2.9cm; the axillary border of the scapula was 13.4cm; the thicknesses of the upper 1/3, middle 1/3, and lower 1/3were 13.9cm,11.0cm, and 7.4cm respectively. From the results of measurement, the subscapular artery pedicled graft of axillary border of scapular could be designed for repair the defects of upper or middle ments of humerus.
ObjectiveTo investigate the effectiveness of the opposite Judet approach for internal fixation of scapula neck and body fractures with reconstruction plate. MethodsBetween February 2008 and November 2012, 44 cases of scapula neck and body fractures were treated through the opposite Judet approach for internal fixation with reconstruction plate. There were 34 males and 10 females with a mean age of 31 years (range, 20-53 years). Fractures were caused by traffic accident in 30 cases, by falling from height in 10 cases, and by crashing of heavy object in 4 cases. Of 44 cases, 6 were classified as type Ⅱ A, 14 as type Ⅱ B, 4 as type Ⅱ C, and 20 as type Ⅳ fractures according to Miller standard. The mean time between operation and trauma was 11 days (range, 5-20 days). The glenopolar angle and the glenoid bank angle were measured on the anterior scapula X-ray films. The shoulder functions were evaluated according to the Rowe's scoring system. ResultsThe mean operation time was 80 minutes (range, 60-110 minutes). The mean intraoperative blood loss was 200 mL (range, 100-400 mL). Superficial wound infection occurred in 2 cases at 5 days after operation, and was cured after change dressing without dysfunction. Primary healing of incision was obtained in the other cases. All cases were followed up 12-23 months (mean, 18.3 months). No nerve or blood vessel injury, breakage of internal fixation, fracture displacement, bone nonunion, or osteomyelitis occurred. The glenopolar angle and glenoid bank angle were significantly improved from (17.08±3.28)°and (23.52±4.35)°before operation to (36.24±5.89)°and (9.27±2.12)°at 6 months after operation respectively (t=18.792, P=0.001;t=19.503, P=0.001). According to Rowe's scoring system for evaluation of shoulder function, the results were excellent in 32 cases, good in 8 cases, and fair in 4 cases at 1 year after operation; the excellent and 6 months good rate was 90.9%. ConclusionOpposite Judet approach for internal fixation of scapula neck and body fractures with reconstruction plate has the advantages of less rotator cuff injury, complete exposure of the scapula two column structure through the three gaps, and easy operation, and the satisfactory fracture reduction and rigid fixation can be obtained.
ObjectiveTo investigate the effectiveness of posterior minimally invasive approach for internal fixation of displaced scapula fractures. MethodsBetween January 2006 and December 2011,16 patients with scapular fractures underwent surgical fixation by a minimally invasive approach,including 11 cases of displaced glenoid fractures and 5 cases of unstable scapular neck/body fractures.There were 12 males and 4 females,aged 35-69 years (mean,53 years).The causes of injury were traffic accident in 10 cases,falling from height in 4 cases,and tumble in 2 cases.In 11 cases of displaced glenoid fractures,6 were rated as Ideberg type Ⅱ,2 as Ideberg type Ⅲ,1 as Ideberg type IV,and 2 as Ideberg type V,with a fracture displacement of more than 3 mm.In 5 cases of unstable scapular neck/body fractures,there were 3 cases of scapular neck fractures and 2 cases of scapular body fractures,with a fracture end angulation of more than 20°;3 cases had floating shoulder injury.The interval of injury and operation was 4-14 days (mean,6 days). ResultsThe mean operation time was 105.8 minutes;the mean intraoperative blood loss was 105.8 mL,and the mean hospitalization time was 17.6 days.Three patients had inflammation around the surgical incision,which was controlled by change dressing;primary healing of incision was obtained in the others.The patients were followed up 12-36 months (mean,24 months);all fractures healed within 12-19 weeks (mean,15.8 weeks).There was no implant failure or deep infection.Constant shoulder score,disability of the arm,shoulder,and hand (DASH) score,and visual analogue scale (VAS) score at post-operation had a significant improvement when compared with scores at pre-operation (P<0.05),but no significant difference was found between different time points at post-operation (P>0.05).Shoulder joint activities were gradually restored during the follow-up;the shoulder range of motion in elevation,abduction,internal rotation,and external rotation at 12 months after operation and last follow-up were significantly higher than those at 6 months after operation (P<0.05),but difference was not significant between at 12 months and last follow-up (P>0.05). ConclusionPosterior minimally invasive approach for internal fixation has good effectiveness in treating displaced scapula fractures,with the advantages of no need for a large subcutaneous flap and an extensive Judet incision or creation of muscular flaps.
ObjectiveTo 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.MethodsBetween 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.ResultsThe 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). ConclusionCompared 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.
ObjectiveTo evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors.MethodsA clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing’s sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph.ResultsPoor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively.ConclusionReconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.
ObjectiveTo investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.MethodsBetween January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.ResultsAll incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly (P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores (P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%.ConclusionDouble internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.
ObjectiveTo investigate the effectiveness of three-dimensional (3D) printed total scapula for reverse shoulder arthroplasty in the treatment of scapular tumors. MethodsBetween November 2017 and December 2021, 5 patients with scapular tumors were treated by reverse shoulder arthroplasty with 3D printed total scapula. There was 1 male and 4 females. The age ranged from 44 to 59 years, with an average of 50.4 years. There were 2 cases of chondro sarcoma, 1 case of high-grade osteosarcoma, 1 case of lung cancer with scapular metastasis, and 1 case of ligamentoid fibromatosis recurrence. The disease duration was 4-8 months, with an average of 5.8 months. According to the Musculoskeletal Tumor Society (MSTS) scapular girdle classification criteria, 4 cases of tumors involved both S1 and S2 zones, and 1 case involved S2 zone. The tumor diameters ranged from 4.2 to 11.2 cm, with an average of 6.1 cm. The operation time, intraoperative blood loss, and blood transfusion were recorded. During follow-up, the MSTS score was used to evaluate the recovery of limb function of the patients. The sink depth of the affected shoulder, complications, and oncological outcomes were observed. The position of the prosthesis was reviewed by imaging. ResultsThe operation time ranged from 155 to 230 minutes, with an average of 189 minutes. The intraoperative blood loss was 100-1 500 mL, with a median of 600 mL. Two patients were received blood transfusion of 800 mL and 1 850 mL respectively during operation. All incisions healed by first intention, and no complications such as infection occurred. All patients were followed up 4-22 months, with an average of 13 months. Two patients died at 8 and 15 months after operation respectively due to multiple metastases and organ failure. At last follow-up, the MSTS score of all patients was 73%-83%, with an average of 77.4%. The affected shoulder was 2-4 cm lower than the contralateral side, with an average of 3 cm. Imaging examinations showed that no prosthesis loosening, dislocation, or fracture occurred during follow-up. Conclusion Reverse shoulder arthroplasty with 3D printed total scapula can obtain good shoulder function and appearance. Patients have high acceptance and satisfaction with this surgical method.