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Clure C, Sheeder J, Lazorwitz A. Pilot study of a novel, alternative subdermal scapular insertion site for the etonogestrel contraceptive implant. Contraception 2024; 135:110442. [PMID: 38552822 DOI: 10.1016/j.contraception.2024.110442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES To assess the pharmacokinetics and pharmacodynamics of the etonogestrel (ENG) contraceptive implant when inserted at an alternative scapular site. STUDY DESIGN We conducted a pilot study of healthy, reproductive-age females who underwent subdermal insertion of an ENG implant over the inferior edge of the nondominant scapula (scapular insertion). We measured serum ENG levels over 1 year at nine time points. Participants completed questionnaires on insertion site and bleeding side effects. We collected photographs and video recordings of insertion and removal techniques. RESULTS We enrolled five participants (as prespecified), their median age was 26.0 years (range: 19.6-30.3), and median body mass index was 25.0 kg/m2 (range: 22.0-28.0). All serum ENG concentrations remained >90 pg/mL and were within the range of published data for arm insertion of ENG implant at all time points. The mean serum ENG level was 511.7 pg/mL (±168.2) at 1 week and 136.6 pg/mL (±21.8) at 12 months. During the first week after insertion, four of five participants noted insertion site pain with a median pain score of 2 (range 1-3), but all noted resolution by week two. Participants reported variable bleeding patterns consistent with standard ENG implant placement. At the end of the study, all participants reported satisfaction with the implant and would recommend scapular insertion to a friend. CONCLUSIONS Scapular insertion of the ENG contraceptive implant has similar pharmacokinetics to arm insertion over 1 year of use. This novel, alternative site was well tolerated and demonstrated similar bleeding side effects to standard arm insertion. IMPLICATIONS Subdermal scapular insertion of the etonogestrel contraceptive implant demonstrated similar pharmacokinetics to arm insertion over 1 year of use. Our pilot data support scapular insertion as an alternative site for ENG contraceptive implants, which could be beneficial for certain patient populations.
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Affiliation(s)
- Cara Clure
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Jeanelle Sheeder
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Aaron Lazorwitz
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States.
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Brahme IS, Cole PA. The Scapular Skiver Screw: A Useful Fixation Technique for Inferior Glenoid and Scapular Neck Fractures. J Orthop Trauma 2024; 38:e267-e271. [PMID: 38837214 DOI: 10.1097/bot.0000000000002815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
SUMMARY The inferior glenoid and scapular neck are common locations for scapular fractures. Operative exposures for reduction and fixation can be challenging, and frequently, the proximal fracture planes are not conducive to optimal fixation with a plate alone. The purpose of this article was to describe a new technique for enhancing fixation in specific inferior glenoid fractures using a single cortical lag screw.
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Affiliation(s)
- Indraneel S Brahme
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN; and
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN; and
- HealthPartners Orthopaedics & Sports Medicine, Bloomington, MN
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Shi H, Zhang K, Hu Y, Wu W, Liu N, Lu H. Novel Claw-shaped Bone Plate in Complex Unstable Scapular Neck and Body Fractures: Comparison with Reconstruction Locking Plate. Orthop Surg 2023; 15:2124-2131. [PMID: 37226558 PMCID: PMC10432470 DOI: 10.1111/os.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE For complex and unstable scapular fractures requiring simultaneous fixation of the glenoid neck, the lateral margin of the body, and/or the scapular diaphysis, reconstruction locking plate is difficult to achieve satisfactory fixation. In order to optimize the fixation effect, the newly designed claw-shaped bone plate was designed for fixing such fractures. We also evaluate the clinical effects and follow-up at an average of 1 year after treatment in scapular internal fixation by using reconstruction locking plate and claw-shaped bone plate in complex unstable scapular body and glenoid neck fracture. METHODS A retrospective study was conducted from 2018 to 2021, thirty-three patients (27 males and six females) who were defined unstable scapular fractures by Ada-Miller. Fifteen patients (52.86 ± 8.26 years) received claw-shaped bone plate and 18 cases (51.61 ± 11.31 years) received reconstruction locking plate with the intermuscular approach. The clinical effect was evaluated based on the operation time, intraoperative blood loss, surgical complications, clinical healing time and Constant-Murley score (CMS). The data analysis by Student t, Mann-Whitney U test and Pearson's chi squared test. RESULTS Compared with reconstruction locking plate, the claw-shaped bone plate showed shorter operation time (102.73 ± 18.43 min vs. 156 ± 37.53, P < 0.0001), higher CMS (94.00 ± 4.07 vs. 89.88 ± 5.42, P = 0.02) and no differences between the two groups regarding intraoperative blood loss (208.00 ± 96.45 mL vs. 269.44 ± 120.21, P = 0.12) and clinical healing times (9.96 ± 1.52 vs. 10.05 ± 1.67, P = 0.87). Follow-up were conducted at first, third, 6 and 12 months after surgery. The operation was successful in all patients with no intraoperative complications. CONCLUSIONS For the treatment of complex and unstable scapular neck body fractures, the application of claw-shaped bone plate demonstrated short operation time, better stability of the fracture block, and higher CMS. In the intraoperative and postoperative follow-up showed better clinical results and rehabilitation effects.
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Affiliation(s)
- Huiming Shi
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Kun Zhang
- Orthopaedics Department of Xi'an Honghui HospitalXi'anChina
| | - Yuanjun Hu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Wei Wu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Ning Liu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Haixia Lu
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
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Deltoid-Sparing Modified Judet Approach: Technique and Clinical Series. J Orthop Trauma 2023; 37:e181-e187. [PMID: 36922392 DOI: 10.1097/bot.0000000000002452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 03/18/2023]
Abstract
SUMMARY Posterior approaches provide the mainstay for treatment in most of the scapula body and neck fractures, even those associated with many intraarticular variants. Several posterior approach modifications for minimizing soft-tissue damage and limiting muscular detachment, have previously been described in the literature; however, little or no clinical evidence is available specifically applied to the various approaches.In this study, we describe complete sparing of the deltoid muscle origin during the "modified Judet" approach. The modified approach as previously described detaches the deltoid origin. Deltoid sparing allows for satisfactory visualization and fixation of extra-articular scapula fractures and even some intraarticular variants. The purpose of this article was to describe the deltoid-sparing modified Judet approach and report clinical outcomes for 23 patients after surgical treatment.
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5
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Dimopoulos L, Antoniadou T, Desai C, Nikolaides AP, Kalogrianitis S. Operative treatment of complex intra-articular scapular fractures: long-term functional outcomes in a single-center study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03323-x. [PMID: 35789295 DOI: 10.1007/s00590-022-03323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Scapula fractures occur in the setting of high-energy trauma. Operative treatment of complex intra-articular scapular fractures can result in adequate surgical and functional outcomes. MATERIALS AND METHODS Twenty-seven patients with complex, displaced intra-articular scapular fractures with or without involvement of the scapular body, were treated operatively in a single trauma center between 2010 and 2021. Associated injuries such as ipsilateral upper limb fractures and nerve injuries were identified in the majority of the patients. Fixation with anatomical medial and lateral border precontoured plates was utilized following posterior modified Judet approach or/and anterior deltopectoral approach. Functional outcome was assessed using the Oxford Shoulder Score and detailed shoulder range of motion and return to work/activities data were obtained. RESULTS At a mean follow-up of 69 months (range 4-135 months), individual functional outcomes for 25 of the 27 patients revealed a mean Oxford Shoulder Score of 33 (69%), mean active flexion of 120 degrees, active abduction of 110 degrees, mean active external rotation of 35 degrees and mean internal rotation to the level of T5. All patients were pain-free at the latest follow-up, and 23 of 25 had returned to their preinjury occupation and activities. CONCLUSION Operative treatment for these complex injuries is a viable option at centers equipped to handle critically ill patients and can result in satisfactory range of motion and functional score measurements along with a relatively low number of complications.
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Affiliation(s)
- L Dimopoulos
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK.
| | - T Antoniadou
- Hand - Upper Limb & Microsurgery Department, Athens Medical Center, Athens, Greece
| | - Chaitya Desai
- University Hospitals of North Midlands NHS Trust, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK
| | - A P Nikolaides
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Socrates Kalogrianitis
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
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Douglass BW, Midgaard KS, Nolte PC, Elrick BP, Tanghe KK, Brady AW, Provencher MT. Neurovascular Anatomic Locations and Surgical Safe Zones When Approaching the Posterior Glenoid and Scapula: A Quantitative and Qualitative Cadaveric Anatomy Study. Arthrosc Sports Med Rehabil 2022; 4:e943-e947. [PMID: 35747623 PMCID: PMC9210384 DOI: 10.1016/j.asmr.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To characterize the qualitative anatomy of posterior scapula structures encountered with the Judet approach and to perform a quantitative evaluation of these structures’ anatomic locations, including their relationships to osseus landmarks to identify safe zones. Methods Twelve fresh-frozen cadaveric shoulders (mean age, 55.2 years; range 41-64 years; 5 left, 7 right) were dissected. A coordinate measuring machine was used to collect the coordinates of anatomic landmarks, structures at risk during surgical approach to the posterior scapula, and the footprints of muscle attachments on the posterior scapula. These coordinates were analyzed for their relationships with clinically relevant anatomy. Results The suprascapular nerve was a mean of 20.3 mm (18.9-21.7 mm) medial to the glenoid 9-o’clock position. The posterior circumflex artery and vein were a mean of 100.0 mm (92.2-107.7 mm) lateral to along the lateral border of the scapula from the inferior angle of the scapula and a mean of 41 mm (34.2-47.9 mm) medial along the lateral scapular border from the 6-o’clock position on the glenoid rim. The long head of the triceps covers a mean of 132 mm2, and it was found to be contiguous with the glenoid capsule at the 6-o’clock position. Conclusions A safe zone exists 19 mm medially from the glenoid 9-o’clock position to the suprascapular nerve and a minimum of 34.2 mm medially along the lateral scapular border from the glenoid 6 o’clock to the posterior circumflex scapular artery. Clinical Relevance The modified Judet approach is a minimally invasive surgery that reduces surgical trauma but necessitates precise knowledge of scapular neurovascular anatomy. Surgeons should be aware of these intervals to help avoid these structures when working near the posterior shoulder. This study may allow us to define neurovascular safe zones when this approach is used.
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Affiliation(s)
- Brenton W. Douglass
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Kaare S. Midgaard
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway
| | - Philip C. Nolte
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
| | | | - Kira K. Tanghe
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Alex W. Brady
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
- Address correspondence to: Matthew T. Provencher, M.D., M.B.A., CAPT., M.C., U.S.N.R. (Ret.), The Steadman Clinic, 181 West Meadow Dr., Suite 1000, Vail, CO 81657.
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Alaia EF, Day MS, Alaia MJ. Entrapment Neuropathies of the Shoulder. Semin Musculoskelet Radiol 2022; 26:114-122. [PMID: 35609573 DOI: 10.1055/s-0042-1742752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Entrapment neuropathies of the shoulder most commonly involve the suprascapular or axillary nerves, and they primarily affect the younger, athletic patient population. The extremes of shoulder mobility required for competitive overhead athletes, particularly in the position of abduction and external rotation, place this cohort at particular risk. Anatomically, the suprascapular nerve is most prone to entrapment at the level of the suprascapular or spinoglenoid notch; the axillary nerve is most prone to entrapment as it traverses the confines of the quadrilateral space.Radiographs should be ordered as a primary imaging study to evaluate for obvious pathology occurring along the course of the nerves or for pathology predisposing the patient to nerve injury. Magnetic resonance imaging plays a role in not only identifying any mass-compressing lesion along the course of the nerve, but also in identifying muscle signal changes typical for denervation and/or fatty atrophy in the distribution of the involved nerve.
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Affiliation(s)
- Erin F Alaia
- Musculoskeletal Division, Department of Radiology, NYU Langone Health, New York, New York
| | - Michael S Day
- WellSpan Orthopedic Group, Chambersburg, Pennsylvania
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital/NYU Langone Health, New York, New York
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Garcia JC. Robotic Transfer of the Latissimus Dorsi for Irreparable Subscapularis Tear. Arthrosc Tech 2022; 11:e1059-e1064. [PMID: 35782843 PMCID: PMC9244639 DOI: 10.1016/j.eats.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/07/2022] [Indexed: 02/03/2023] Open
Abstract
This Technical Note presents an endoscopic robotic anterior axillary shoulder approach using of the DaVinci (Intuitive Surgical, Sunnyvale, CA) robot, which allows one to endoscopically access and harvest the latissimus dorsi tendon for occasions in which the patient presents an irreparable lesion of the subscapularis tendon. Harvesting the latissimus dorsi through an anterior axillary approach is specially desirable when one needs to access the anterior portion of the shoulder, as happens for subscapularis irreparable lesions.
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Affiliation(s)
- Jose Carlos Garcia
- NAEON Institute, São Paulo-Brazil and Moriah Hospital, São Paulo, Brazil,Address correspondence to Jose Carlos Garcia, Jr., M.D., Ph.D., NAEON-São Paulo, Brazil, Avenida Ibirapuera 2144, cj 82, Sao Paulo-SP-Brazil 04028-001.
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9
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Singal A, Gupta T, Aggarwal A, Sahni D. Osseous deficiencies, pockets, superfluous lateral border thickening in scapula: a rare occurrence. Surg Radiol Anat 2022; 44:621-625. [PMID: 35266029 DOI: 10.1007/s00276-022-02920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Beyond the nutrient and suprascapular foramen, the other foramina, holes or osseous deficiencies, pockets has rarely been reported in scapula. If present, the bony holes or deficiencies may lead to radiolucent areas and may be mistaken for sites of osteolytic destruction related to skeletal metastases, multiple myeloma or others. CASE REPORT In the present case of left scapula, unusual osseous deficiencies of different size and shape along with pockets were observed in the body of scapula. The maximum height and width of largest bony deficiency was 35.8 mm and 12.6 mm. There was abnormal osseous thickening beside the lateral border of scapula along with the presence of some spines. Five nutrient foramina, three on the costal and two on the dorsal surface were noticed. CONCLUSIONS The present case reports the osseous deficiencies, pockets and extra osseous growth along the lateral border, multiple nutrient foramina altogether in one specimen. Thorough anatomical knowledge of these unusual osseous variations can provide the clinicians, radiologists and forensic experts with better clinical judgement and may add insight to the surgical planning by orthopaedic surgeons.
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Affiliation(s)
- Anjali Singal
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chuang CH, Huang CK, Li CY, Hu MH, Lee PY, Wu PT. Surgical stabilization of the ipsilateral scapula and rib fractures using the mirror Judet approach: a preliminary result. BMC Musculoskelet Disord 2022; 23:105. [PMID: 35101018 PMCID: PMC8802444 DOI: 10.1186/s12891-021-04991-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report our preliminary results using a single approach, the mirror Judet approach, for patients with both ipsilateral scapula and multiple rib fractures. METHODS Five consecutive patients [median age: 56 years (range: 44 ~ 60)] with ipsilateral scapula and multiple rib fractures that met the surgical indications were retrospectively reviewed. A single approach, the mirror Judet approach, was used for surgical stabilization of the scapula and targeted rib fractures. Thoracoscopic surgery was performed first for management of associated lung lesions and marking the targeted rib. All patients received the same rehabilitation protocol and a minimum 12-month follow-up. RESULTS All surgically-fixed fractures eventually united without malunion. No complaints of intercostal neuralgia, infection, or other complications were seen. The mean range of motion in the injured shoulder returned to at least 90% of the contralateral side range. The mean Disabilities of the Arm, Shoulder, and Hand score at the 12th month was 2.0 (range: 0-7). All patients were able to return to their previous work. CONCLUSION The mirror Judet approach allows for the surgical stabilization of the ipsilateral scapula and multiple rib fractures using the same approach and provides acceptable functional outcomes in well-selected patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chang-Han Chuang
- Department of Orthopaedic Surgery, Show Chwan Memorial Hospital, 524 Sec. 1 Chung-Shan Rd., Changhua, 500, Taiwan.,Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chin-Kai Huang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ying Li
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Hsien Hu
- Department of Orthopaedic Surgery, Show Chwan Memorial Hospital, 524 Sec. 1 Chung-Shan Rd., Changhua, 500, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Yuan Lee
- Department of Orthopaedic Surgery, Show Chwan Memorial Hospital, 524 Sec. 1 Chung-Shan Rd., Changhua, 500, Taiwan. .,College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan.
| | - Po-Ting Wu
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan. .,Department of Orthopedics, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan. .,Department of Orthopedics, National Cheng Kung University Hospital Dou-Liou branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan. .,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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Structures Endangered During Minimally Invasive Plate Osteosynthesis of the Upper Extremity. J Am Acad Orthop Surg 2021; 29:e782-e793. [PMID: 33902084 DOI: 10.5435/jaaos-d-20-00799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/30/2021] [Indexed: 02/01/2023] Open
Abstract
Minimally invasive plate osteosynthesis is a surgical technique that is becoming increasingly common because radiographic images and implant technologies advance in capabilities. It is imperative for surgeons to enhance their understanding of the surgical anatomy related to new approaches for fracture fixation. While performing minimally invasive plate osteosynthesis, there is a danger of injuring structures in the common percutaneous and submuscular pathways. We describe the critical anatomical structures in these pathways and tips for injury avoidance when operating on the clavicle, scapula, humerus, and wrist.
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12
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Robotic Transfer of the Latissimus Dorsi Associated With Levator Scapulae and Rhomboid Minor Mini-Open Transfers for Trapezium Palsy. Arthrosc Tech 2020; 9:e1721-e1726. [PMID: 33294332 PMCID: PMC7695592 DOI: 10.1016/j.eats.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/18/2020] [Indexed: 02/03/2023] Open
Abstract
Robotic surgery has been used for a long time. With advantages over traditional surgical methods, it is earning space and expanding use to daily medical practice in several surgical specialties. This Technical Note presents an endoscopic robotic posterior shoulder approach using the DaVinci® robot. It can allow the surgeon to perform latissimus dorsi transfer endoscopically and associate it with levator scapulae and rhomboid minor mini-open transfers to treat accessory nerve lesions with trapezium muscle palsy. This technique is an alternative to Eden-Lange and triple-tendon transfer.
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13
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Cohn MR, Cregar WM, Drager J, Lu Y, Garrigues GE. Suprascapular Nerve Entrapment due to an Ossified Spinoglenoid Ligament After Scapular Fracture: A Case Report. JBJS Case Connect 2020; 10:e2000477. [PMID: 33784447 DOI: 10.2106/jbjs.cc.20.00477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 46-year-old man underwent open reduction and internal fixation (ORIF) of left scapular, humerus, and clavicle fractures after a snowmobile accident. He subsequently developed severe left infraspinatus weakness with electromyogram evidence of suprascapular entrapment at the spinoglenoid notch. Intraoperatively, suprascapular nerve compression from an ossified spinoglenoid ligament was observed. Scapular hardware was removed, the ossified ligament was resected, and neurolysis was performed. At 6 months postoperatively, the patient demonstrated return of infraspinatus function. CONCLUSION An ossified spinoglenoid ligament can contribute to suprascapular neuropathy after scapular fracture and ORIF. Open resection of the ossified ligament may lead to improved infraspinatus function.
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Affiliation(s)
- Matthew R Cohn
- 1Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Garcia JC, Cordeiro EF, Raffaelli MDP, Dumans Mello MB, Kozonara ME, Cardoso ÁDM, Torres MC. Robotic Transfer of the Latissimus Dorsi. Arthrosc Tech 2020; 9:e769-e773. [PMID: 32577350 PMCID: PMC7301275 DOI: 10.1016/j.eats.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/04/2020] [Indexed: 02/03/2023] Open
Abstract
Robotic surgery has been used for a long time; it is earning space and its use is expanding in daily medical practice in several surgical specialties, with advantages over traditional surgical methods. This Technical Note presents an endoscopic robotic posterior shoulder approach that allows the surgeon to perform latissimus dorsi transfer endoscopically. This Technical Note describes the use of the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) for transfers related to rotator cuff tears.
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Affiliation(s)
- Jose Carlos Garcia
- NAEON Institute, São Paulo, Brazil,Address correspondence to Jose Carlos Garcia Jr, M.D., Ph.D., NAEON Institute, Avenida Ibirapuera 2144, cj 82, Sao Paulo (SP), Brazil, 04028-001.
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15
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Three-dimensional topography of scapular nutrient foramina. Surg Radiol Anat 2020; 42:887-892. [PMID: 32112283 PMCID: PMC7347675 DOI: 10.1007/s00276-020-02441-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/10/2020] [Indexed: 12/03/2022]
Abstract
Purpose The aim of this study is to describe the number and location of the nutrient foramina in human scapulae which can minimize blood loss during surgery. Methods 30 cadaveric scapulae were macerated to denude the skeletal tissue. The nutrient foramina of 0.51 mm and larger were identified and labeled by adhering glass beads. CT scans of these scapulae were segmented resulting in a surface model of each scapula and the location of the labeled nutrient foramina. All scapulae were scaled to the same size projecting the nutrient foramina onto one representative scapular model. Results Average number of nutrient foramina per scapula was 5.3 (0–10). The most common location was in the supraspinous fossa (29.7%). On the costal surface of the scapula, most nutrient foramina were found directly inferior to the suprascapular notch. On the posterior surface, the nutrient foramina were identified under the spine of the scapula in a somewhat similar fashion as those on the costal surface. Nutrient foramina were least present in the peri-glenoid area. Conclusion Ninety percent of scapulae have more than one nutrient foramen. They are located in specific areas, on both the posterior and costal surface.
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GAO M, NIE D, CHANG Y, XIE W, WANG Y, PU X, ZHANG W, LUO W. [Internal fixation of lateral and medial borders for displaced scapular body fractures via minimally invasive approach:results of 23 cases]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:651-656. [PMID: 31955540 PMCID: PMC8800703 DOI: 10.3785/j.issn.1008-9292.2019.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy of internal fixation of lateral and medial borders for displaced scapular body fractures via the minimally invasive approach. METHODS The internal fixation of lateral and medial borders via minimally invasive approach was applied in surgical treatment of 23 patients with scapular body comminuted fractures from January 2014 to June 2018. The lateral approach was made straightly orienting over the lateral border of scapula. The dissection was taken down to the deltoid fascia. The deltoid was retracted cephalically, revealing the external rotators. Blunt dissection was used down to the lateral border between infraspinatus and teres minor, exposing the fracture site. The medial incision was done along the medial border of the scapula over site of the fracture. Dissections were taken down to the fascia and the periosteum. A subperiosteal dissection was then performed to elevate the infraspinatus to the degree necessary to visualize the fracture. The medial and lateral borders of scapula body were fixed with plates and screws in a frame-like way. RESULTS One patient developed the delayed healing of the incisions due to liquefactive fat necrosis. The other 22 patients showed no complications of the incisions. The glenopolar angle (GPA) of fractured scapula was increased from preoperative (25±12) degrees to postoperative (41±5) degrees (P<0.01). The healing time of fractures healed was 3-8 months, with an average time of (4.4±1.3) months. CONCLUSIONS The lateral-medial combined fixation through minimally invasive surgical approach for the scapula body fractures allows visualization of fracture reduction without extensive muscular or subcutaneous flaps, and is associated with successful fracture healing and high functional scores of the shoulder.
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Affiliation(s)
| | | | | | | | | | | | | | - Wenyuan LUO
- 骆文远(1966-), 男, 学士, 主任医师, 硕士生导师, 主要从事老年骨科疾病基础与临床研究, E-mail:
;
https://orcid.org/0000-0002-8500-4734
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van Trikt CH, Dobbe JGG, Donders JCE, Streekstra GJ, Kloen P. The "coracoid tunnel view": a simulation study for finding the optimal screw trajectory in coracoid base fracture fixation. Surg Radiol Anat 2019; 41:1337-1343. [PMID: 31273419 PMCID: PMC6841653 DOI: 10.1007/s00276-019-02274-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Coracoid fractures represent approximately 3-13% of all scapular fractures. Open reduction and internal fixation can be indicated for a coracoid base fracture. This procedure is challenging due to the nature of visualization of the coracoid with fluoroscopy. The aim of this study was to develop a fluoroscopic imaging protocol, which helps surgeons in finding the optimal insertion point and screw orientation for fixations of coracoid base fractures, and to assess its feasibility in a simulation study. METHODS A novel imaging protocol was defined for screw fixation of coracoid base fractures under fluoroscopic guidance. The method is based on finding the optimal view for screw insertion perpendicular to the viewing plane. In a fluoroscopy simulation environment, eight orthopaedic surgeons were invited to place a screw down the coracoid stalk through the coracoid base and into the neck of 14 cadaveric scapulae using anatomical landmarks. The surgeons placed screws before and after they received an e-learning of the optimal view. Results of the two sessions were compared and inter-rater reliability was calculated. RESULTS Screw placement was correct in 33 out of 56 (58.9%) before, and increased to 50 out of 56 (89.3%) after the coracoid tunnel view was explained to the surgeons, which was a significant improvement (p < 0.001). CONCLUSIONS Our newly developed fluoroscopic view based on simple landmarks is a useful addendum in the orthopaedic surgeon's tool box to fixate fractures of the coracoid base.
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Affiliation(s)
- C H van Trikt
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J C E Donders
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Pragout D, Darrouzain F, Marret H. Alternative insertion site in the scapular region for etonogestrel contraceptive implant (Nexplanon ®). Eur J Obstet Gynecol Reprod Biol 2018; 224:207-208. [PMID: 29615330 DOI: 10.1016/j.ejogrb.2018.03.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- David Pragout
- CHRU de Tours, Department of Obstetrics and Gynecology, Division of Family Planning, 2 Boulevard Tonnellé, F-37044 Tours Cedex 9, France.
| | - Francois Darrouzain
- CHRU de Tours, Department of Pharmacology and Toxicology, F-37044 Tours, France; Université François Rabelais de Tours, CNRS UMR 7292 GICC, F-37032 Tours, France
| | - Henri Marret
- CHRU de Tours, Department of Obstetrics and Gynecology, F-37044 Tours, France; Université François Rabelais de Tours, Faculté de Médecine de Tours, F-37032 Tours, France; UMR Inserm U 930, Université François Rabelais de Tours, F-37032 Tours, France
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Hess F, Zettl R, Smolen D, Knoth C. Decision-making for complex scapula and ipsilateral clavicle fractures: a review. Eur J Trauma Emerg Surg 2018; 45:221-230. [PMID: 29572729 DOI: 10.1007/s00068-018-0946-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Complex scapula with ipsilateral clavicle fracures remains a challange and treatment recommendations are still missing. This review provides an overview of the evolution of the definition, classification and treatment strategies for complex scapula and ipsilateral clavicle fractures. As with other rare conditions, consensus has not been reached on the most suitable management strategies to treat these patients. The aim of this review is twofold: to compile and summarize the currently available literature on this topic, and to recommend treatment approaches. MATERIALS AND METHODS Included in the review are the following topics: biomechanics of scapula and ipsilateral clavicle fractures, preoperative radiological evaluation, surgical treatment of the clavicle only, surgical treatment of both the clavicle and scapula, and nonsurgical treatment options. RESULTS A decision-making algorithm is proposed for different treatment strategies based on pre-operative parameters, and an example of a case treated our institution is presented to illustrate use of the algorithm. DISCUSSION The role of instability in complex scapula with ipsilateral clavicle fractures remains unclear. The question of stability is preoperatively less relevant than the question of whether the dislocated fragments lead to compromised shoulder function.
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Affiliation(s)
- Florian Hess
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
| | - Ralph Zettl
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | | | - Christoph Knoth
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
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20
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Manouvakhova OV, Macchi V, Fries FN, Loukas M, De Caro R, Oskouian RJ, Spinner RJ, Tubbs RS. Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures. Oper Neurosurg (Hagerstown) 2018; 14:166-170. [PMID: 29351679 DOI: 10.1093/ons/opx096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon. OBJECTIVE To identify landmarks for the identification of this hidden site within an anterior approach. METHODS In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen. RESULTS From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°. CONCLUSION Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm.
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Affiliation(s)
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Fabian N Fries
- Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada.,Seattle Science Foundation, Seattle, Washington
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21
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Dugarte AJ, Tkany L, Schroder LK, Petersik A, Cole PA. 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; 36:265-271. [PMID: 28543704 DOI: 10.1002/jor.23603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/28/2017] [Indexed: 02/04/2023]
Abstract
Fracture mapping has been used in the understanding of injury patterns in different bones. To our knowledge, there are no applications of this technique using three-dimensional (3D) morphologic fracture characteristics. Previously, scapula fractures were mapped by transferring information from 3D computed tomography to a two-dimensional (2D) template. Cole et al. determined that 3D Computerized Tomography (CT) scans were more reliable compared to plain radiographs in terms of scapular angulation, translation, and glenopolar angle measurements. Thus, we hypothesized that if there is a difference between fracture lines drawn in 3D and in 2D, then the 3D mapping would yield more accurate fracture patterns. We completed a retrospective, comparative study (evidence level III) utilizing CT imaging from a single center scapular registry. We studied ten patients with scapula fractures in whom bilateral CT scans were obtained. Fractures were mapped both two and three-dimensionally, and we measured deviations between the fracture lines that were drawn with each approach. The measured deviations ranged from 10.4 mm to 28.0 mm when comparing 2D versus 3D techniques, with the mean deviation being 4.0 mm and 10.4 mm, respectively. Half of the 2D renderings possessed hidden fracture lines that were later revealed on 3D imaging. Three-dimensional renderings were more accurate when compared to 2D fracture mapping methods. This more accurate technique will allow for better understanding of 3D morphology and provide a basis for future fracture mapping in any bone. Accurate mapping is important because surgical approach, reduction, fixation, and implant design and selection are based on fracture patterns. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:265-271, 2018.
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Affiliation(s)
- Anthony J Dugarte
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, St. Paul, Minnesota
| | | | - Lisa K Schroder
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, St. Paul, Minnesota
| | | | - Peter A Cole
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, St. Paul, Minnesota
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Noguchi T, Mautner JF, Duncan SFM. Dorsal Plate Fixation of Scapular Fracture. J Hand Surg Am 2017; 42:843.e1-843.e5. [PMID: 28867251 DOI: 10.1016/j.jhsa.2017.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
Scapular fractures are uncommon injuries. When they occur, they are usually treated nonsurgically. However, certain indications remain for operative intervention for the treatment of these injuries. In this article, we review some operative indications as well as the surgical technique. We present a case to demonstrate the indications and surgical technique of treatment. As with most surgical approaches, technique is critical to minimize morbidity and maximize functional outcome. Using these techniques, operative management of scapular fractures can be successful.
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Affiliation(s)
- Takashi Noguchi
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - James F Mautner
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA
| | - Scott F M Duncan
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
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Shin KJ, Kim JN, Lee SH, Paik DJ, Song WC, Koh KS, Gil YC. Arterial supply and anastomotic pattern of the infraspinous fossa focusing on the surgical significance. J Plast Reconstr Aesthet Surg 2016; 69:512-8. [PMID: 26867469 DOI: 10.1016/j.bjps.2015.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/09/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
Abstract
The clinical significance of the muscular branch of the circumflex scapular artery (CSA) has been underestimated during surgery involving the scapular osteocutaneous free flap, while the suprascapular artery (SSA) is vulnerable to damage during internal fixation of a scapular fracture. This study aimed to provide navigational guidelines for the positions of the suprascapular and circumflex scapular arteries at the infraspinous fossa and to identify the anastomotic pattern. Scapulae were carefully dissected following injection of liquid silicone into the suprascapular and circumflex scapular arteries. The artery diameters and the distances between landmarks were measured. Scapulae were classified according to the anastomotic morphology of the arteries. The suprascapular and circumflex scapular arteries had mean diameters of 1.7 and 2.1 mm, respectively. The mean horizontal distance from the root of the spine to the suprascapular artery was 90.3 mm, and the mean distance between the suprascapular and circumflex scapular arteries was 45.5 mm. The circumflex scapular artery was positioned along the lateral border at 68.7% from the inferior angle. Practical navigational guidelines for the positions of the suprascapular and circumflex scapular arteries have been provided, with the anastomotic pattern classified into two types and two subtypes. The results of the present study will help reduce donor-site morbidity and damage to these arteries during surgery in the scapular region.
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Affiliation(s)
- Kang-Jae Shin
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Jeong-Nam Kim
- Department of Biomedical Laboratory, Masan University, 100 Yongdam-ri, Naeseo-eup, MasanHoiwon-gu, Masan 51217, Republic of Korea.
| | - Shin-Hyo Lee
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Doo-Jin Paik
- Department of Anatomy and Cell Biology, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Wu-Chul Song
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Ki-Seok Koh
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Young-Chun Gil
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
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Salassa TE, Hill BW, Cole PA. Quantitative comparison of exposure for the posterior Judet approach to the scapula with and without deltoid takedown. J Shoulder Elbow Surg 2014; 23:1747-52. [PMID: 24862248 DOI: 10.1016/j.jse.2014.02.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/20/2014] [Accepted: 02/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purposes of this study are to quantify the extent of the scapula exposed and to describe the osseous landmarks within the dissection of a posterior Judet approach with and without takedown of the posterior deltoid muscle. METHODS The posterior Judet approach using the muscular interval between the teres minor and infraspinatus muscle with and without takedown of the deltoid muscle was performed on 10 fresh-frozen cadaveric shoulders. Retractors with 2 kg of force were used at the wound margins for retraction. Upon completion of the exposure, a calibrated digital image was taken from the surgeon's perspective and specific anatomic landmarks were identified. The digital images were then analyzed with a computer software program, ImageJ (National Institutes of Health, Bethesda, MD, USA), to calculate the area (in square centimeters) of bone exposed. RESULTS The mean area of posterior scapula exposed by the traditional Judet approach with takedown of the deltoid muscle was 30.2 cm(2) (95% confidence interval, 27.7-32.7 cm(2)) compared with 27.3 cm(2) (95% confidence interval, 24.8-29.9 cm(2)) when the deltoid was not detached (P < .0001). In all 10 cadaveric shoulders, the posterior Judet approach without takedown of the deltoid muscle allowed access to the posterior glenoid, lateral scapula border, and spinoglenoid notch. CONCLUSIONS Although takedown of the deltoid muscle improves exposure, the posterior Judet approach without takedown of the posterior deltoid muscle allows for safe exposure to 91% of the bony scapula obtained by removing the deltoid muscle and access to the critical osseous fixation points of the posterior scapula.
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Affiliation(s)
- Tiare E Salassa
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, St. Paul, MN, USA
| | - Brian W Hill
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, St. Paul, MN, USA
| | - Peter A Cole
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, St. Paul, MN, USA.
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LaPrade CM, Ellman MB, Rasmussen MT, James EW, Wijdicks CA, Engebretsen L, LaPrade RF. Anatomy of the anterior root attachments of the medial and lateral menisci: a quantitative analysis. Am J Sports Med 2014; 42:2386-92. [PMID: 25106782 DOI: 10.1177/0363546514544678] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the biomechanical importance of the meniscal roots has been demonstrated, the anatomy of the anterior meniscal roots remains largely unknown. Defining the quantitative anatomy of the anterior meniscal root attachments is essential for developing improved diagnostic and surgical techniques. HYPOTHESIS The anterior medial (AM) and anterior lateral (AL) meniscal roots could be quantitatively defined relative to open and arthroscopic surgical landmarks. STUDY DESIGN Descriptive laboratory study. METHODS Twelve nonpaired human cadaveric knees were used (average age, 51.3 years). A coordinate measuring device quantified the anatomic relationships of the AM and AL root attachments to open and arthroscopic surgical landmarks. The tibial attachments of both anterior roots were defined and quantified by categorizing the fibers of the root as either central, dense attachments or peripheral, supplemental attachments. RESULTS The center of the tibial tuberosity and the medial tibial eminence apex were 27.0 mm lateral and distal and 27.5 mm posterior to the center of the AM root, respectively. The center of the anterior cruciate ligament (ACL) and the lateral tibial eminence apex were 5.0 mm posteromedial and 14.4 mm posterolateral to the center of the AL root, respectively. The AM root attachment had a mean area of 110.4 mm(2) (95% CI, 92.2-128.5) with a central attachment of 56.3 mm(2) (95% CI, 46.9-65.8). The AL root attachment had a mean area of 140.7 mm(2) (95% CI, 121.6-159.8) and inserted deeply beneath the ACL in all specimens. The overlap of the ACL on the AL root averaged 88.9 mm(2) (95% CI, 63.3-114.6), comprising 63.2% of the AL root attachment. CONCLUSION The anterior meniscal roots were identified in relation to pertinent open and arthroscopic landmarks. The extended overlap between the AL root and ACL attachment revealed a more intimate tibial attachment relationship than previously recognized. CLINICAL RELEVANCE Quantitative descriptions of the anterior meniscal roots elucidate the relationship between the root attachments and pertinent surgical landmarks. In addition, the supplemental attachments of both menisci may contribute to native meniscal function, and further investigation is recommended.
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Affiliation(s)
- Christopher M LaPrade
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Matthew T Rasmussen
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Evan W James
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado
| | - Coen A Wijdicks
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Lars Engebretsen
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA Department of Orthopaedics, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Robert F LaPrade
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado
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Abstract
Operative fixation of the scapula is associated with good outcomes. Techniques have been developed to facilitate surgical exposure of the osseous anatomy so that stability can be achieved. Although the familiar deltopectoral approach can be used for anterior glenoid fractures, the more common exposure is a posterior approach for fractures involving the neck and body of the scapula. The posterior approach has been nuanced to match needs related to fracture pattern and timing of surgery. Reducing the fragments and stabilizing them can be challenging but, a satisfactory reduction and stable fixation can be achieved, which allows immediate motion and rehabilitation.
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Abstract
The vascular anatomy at the spinoglenoid and suprascapular notches appears to be more variable than previously thought. In patients presenting with signs of suprascapular nerve compression, vascular causes must be considered. Especially when considering percutaneous or arthroscopic treatment, awareness of these entities may help to guide treatment decisions, aid in identification of the anatomy, and prevent unwanted vascular insult.
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Affiliation(s)
- Carlton Houtz
- Highland Clinic, 1455 E Bert Kouns Industrial Loop, Ste 210, Shreveport, LA 71105, USA.
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28
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Shi LL, Freehill MT, Yannopoulos P, Warner JJP. Suprascapular nerve: is it important in cuff pathology? Adv Orthop 2012; 2012:516985. [PMID: 23193484 PMCID: PMC3501891 DOI: 10.1155/2012/516985] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 10/08/2012] [Indexed: 01/02/2023] Open
Abstract
Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.
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Affiliation(s)
- Lewis L. Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637, USA
| | - Michael T. Freehill
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, P.O. Box 1070, Winston-Salem, NC 27157-1070, USA
| | - Paul Yannopoulos
- Division of Shoulder Surgery, Massachusetts General Hospital, Yawkey Center 3G, 55 Fruit Street, Boston, MA 02114, USA
| | - Jon J. P. Warner
- Division of Shoulder Surgery, Massachusetts General Hospital, Yawkey Center 3G, 55 Fruit Street, Boston, MA 02114, USA
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Abstract
With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as allowed by the patient's pain. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. However, little agreement exists on indications for surgery, and there is no clear comparative evidence on outcomes for surgically versus nonsurgically managed fractures. Scapular fractures are the result of high-energy mechanisms of injury, and they often occur in conjunction with other traumatic injuries. In addition to performing meticulous physical and neurologic examination, the surgeon should obtain plain radiographs, including AP shoulder, axillary, and scapular Y views. Three-dimensional CT is used to determine accurate measurements in surgical candidates. Surgical approach, technique, and timing are individualized based on fracture type and other patient-related factors.
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Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Injury 2012; 43:327-33. [PMID: 22036452 DOI: 10.1016/j.injury.2011.09.029] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/26/2011] [Accepted: 09/30/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Certain scapula fractures may warrant surgical management to restore shoulder anatomy and promote optimal function. The purpose of this study is to determine the early radiographic follow-up of open reduction internal fixation (ORIF) for displaced, scapular fractures involving the glenoid neck and body. METHODS Eighty-four patients with a scapula body or neck fracture (with or without articular involvement) underwent ORIF between 2002 and 2010 at a single level I trauma centre. This study represents a retrospective review of data prospectively collected into a dedicated scapula fracture database. All patients met at least one of the following operative criteria: ≥20 mm medial/lateral (M/L) displacement (lateral border offset), ≥45° of angular deformity on a scapular-Y X-ray, the combination of angulation ≥30° plus M/L displacement ≥15 mm, double disruptions of the superior shoulder suspensory complex both displaced ≥10 mm, glenopolar angle (GPA) ≤22° and open fractures. Eighty-eight percent (74/84) had sufficient follow-up defined as at least 6 months. Measured outcomes included rates of scapula union and malunion, as well as surgical complications and re-operations. RESULTS All fractures were caused by high-energy trauma with 24 (29%) resulting from motor-vehicle collisions. Associated injuries occurred in 94% of patients, most commonly involving the chest (70%) and ipsilateral shoulder girdle (43%). Forty-eight patients had M/L displacement as an operative indication with a mean displacement of 25.7 mm (range=20-40). Thirty-eight (45%) had ≥2 operative indications. A single surgeon performed ORIF in all patients using a posterior approach. Five patients also required an anterior (deltopectoral) approach. The fixation strategy included lateral and vertebral border stabilisation with dynamic compression and reconstruction plates, respectively. Union was achieved in all cases. There were three cases of malunion based on a GPA difference >10° from the uninjured shoulder. Re-operations included removal of hardware (seven patients) and manipulation under anaesthesia (three patients). There were no infections or wound dehiscence. CONCLUSIONS ORIF for displaced scapula fractures is a relatively safe and effective procedure for restoration of anatomy and promotion of union. LEVEL OF EVIDENCE Therapeutic study, level IV.
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Affiliation(s)
- Peter A Cole
- University of Minnesota/Regions Hospital, 640 Jackson Street, St. Paul, MN 55101, USA.
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31
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Abstract
Although historically considered a diagnosis of exclusion, suprascapular neuropathy may be more common than once believed, as more recent reports are describing the condition as a cause of substantial pain and weakness in patients with and without concomitant shoulder pathology. The etiology is traction or compression of the suprascapular nerve. This can result from a space-occupying lesion, such as a ganglion cyst, or a traction injury as a result of repetitive overhead activities. More recent studies have cited cases of traction injuries occurring with retraction of a large rotator cuff tear. Atrophy of the infraspinatus and/or supraspinatus rotator cuff muscles with resultant weakness in forward flexion and/or external rotation of the shoulder on physical examination may be demonstrated. Magnetic resonance imaging (MRI) is the preferred modality to assess atrophy of the rotator cuff muscles as well as assess potential causes of suprascapular nerve compression. Electromyography and nerve conduction velocity studies remain the gold standard for confirmation of the diagnosis of suprascapular neuropathy; however, nerve pain may occur even in the setting of a negative electromyography. Initial management is usually nonoperative, consisting of activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs. Surgical intervention is considered for patients with nerve compression by an external source or for symptoms refractory to conservative measures. Decompression of the suprascapular nerve may be accomplished through an open approach, although arthroscopic surgical approaches have become more common in the past several years.
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Affiliation(s)
- Michael T Freehill
- Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
BACKGROUND The approach of choice for open reduction internal fixation of displaced fractures involving the scapula neck or body is from posterior. We describe a new approach that minimizes the surgical insult to the soft tissues but preserves the ability to restore alignment and stability to the fracture. DESCRIPTION OF TECHNIQUE Based on the fracture pattern, incisions are made along the anatomic bony perimeter to access the scapula borders for reduction and fixation. Since the incisions are centered over sites of "perimeter" fracture displacement of this relatively flat bone, minimal soft tissue retraction and less muscular stripping are necessary, while indirect reduction of the intervening scapula body is accomplished to restore anatomic alignment. PATIENTS AND METHODS We retrospectively reviewed seven men with a mean age of 39 years (range, 19-75 years) who underwent open reduction internal fixation of a displaced scapula body or neck fracture using this minimally invasive approach. The minimum followup was 12 months (mean, 16 months; range, 12-23 months). RESULTS Six of the seven patients returned to their original occupation/activities. The mean Disabilities of the Arm, Shoulder and Hand score at followup was 8.1 (range, 0-52; normative mean, 10.1). For all parameters, the mean SF-36 scores of the study patients were comparable to those of the normal population. Both strength and motion returned to equivalency with the uninjured shoulder. There were no intraoperative or postoperative complications. CONCLUSIONS This novel surgical approach to the scapula allows visualization of fracture reduction without an extensile incision or muscular or subcutaneous flaps and was associated with high functional scores. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Erich M. Gauger
- Department of Orthopaedic Surgery, University of Minnesota–Regions Hospital, 640 Jackson Street, St Paul, MN 55101 USA
| | - Peter A. Cole
- Department of Orthopaedic Surgery, University of Minnesota–Regions Hospital, 640 Jackson Street, St Paul, MN 55101 USA
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Extra-articular malunions of the scapula: a comparison of functional outcome before and after reconstruction. J Orthop Trauma 2011; 25:649-56. [PMID: 21697740 DOI: 10.1097/bot.0b013e31820af67f] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess surgical and functional results after corrective reconstruction of malunited, scapula neck or body fractures in patients who presented with chronic pain, limited range of motion, weakness, and gross deformity of the shoulder. DESIGN Case series. SETTING Level I teaching trauma center. PATIENTS Between 2000 and 2008, five patients (mean age, 44 years) underwent operative reconstruction of a malunited, scapula neck and/or body fracture. Mean time from injury to surgery was 15 months (range, 8-41 months). All patients presented with debilitating pain and weakness and were unable to return to work. When measured on three-dimensional computed tomographic scan, mean preoperative fracture deformity included 3.0 cm (range, 1.7-4.2 cm) of medial/lateral displacement, 25° (range, 10°-40°) of angular deformity, and a 25° (range, 19°-29°) glenopolar angle. INTERVENTION Surgical osteotomy and reorientation of scapula neck and/or body, with fixation using 2.7- or 3.5-mm implants and autogenous graft, through a posterior Judet approach. MAIN OUTCOMES MEASURES Pre- and postoperative functional measures of range of motion and strength testing and patient-based outcome scores (Disabilities of the Arm, Shoulder and Hand and Short Form-36). RESULTS Mean follow-up was 39 months (range, 18-101 months). All patients united radiographically, were pain-free with regard to the shoulder, and expressed satisfaction with their result. Four of five patients returned to their original occupation and activities. Mean Disabilities of the Arm, Shoulder and Hand score improved from 39 (range, 27-58) preoperatively to 10 (range, 0-35) postoperatively. There were no complications. CONCLUSIONS Malunion after nonoperative treatment of a displaced scapula fracture may be associated with poor functional and cosmetic outcomes. Operative reconstruction can yield good surgical and functional results.
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Ebraheim NA, Whitehead JL, Alla SR, Moral MZ, Castillo S, McCollough AL, Yeasting RA, Liu J. The suprascapular nerve and its articular branch to the acromioclavicular joint: an anatomic study. J Shoulder Elbow Surg 2011; 20:e13-7. [PMID: 21194975 DOI: 10.1016/j.jse.2010.09.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The suprascapular nerve and its articular branch innervate the acromioclavicular (AC) joint. Documenting the detailed anatomy of this innervation in the AC joint, including the pertinent surgical and anatomic relationships of the suprascapular nerve and its branches to the AC joint, will aid in the prevention of injury and the reduction of risk of denervation during shoulder surgery. MATERIALS AND METHODS Twelve shoulders from 6 embalmed human cadavers were bilaterally dissected to study the course of the suprascapular nerve and its motor and sensory branches. RESULTS The sensory branch runs superiorly to the supraspinatus muscle towards the AC joint. The average distance from the supraglenoid tubercle to the nerve at the coracoid base was 15 mm. The average distance from the coracoclavicular ligaments to the nerve at the coracoid base was 6 mm. The average distance from the spinoglenoid notch to the sensory branch at the suprascapular notch was 22 mm. The average length of the sensory branch was 30 mm. In half of the specimen shoulders, the suprascapular artery accompanied the nerve at the suprascapular notch under the transverse scapular ligament. DISCUSSION The innervation of the AC joint by the suprascapular nerve has been described, along with pertinent distances to anatomic landmarks. The sensory branch of the suprascapular nerve, which passed through the scapular notch inferior to the transverse scapular ligament, was found in 100% of the study specimens. CONCLUSION The sensory branch of the suprascapular nerve runs superiorly to the supraspinatus muscle towards the AC joint. The detailed information can be used to help decrease the risk of nerve injury during shoulder surgery and to aid in effectively diagnosing and treating AC joint-related disorders.
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Affiliation(s)
- Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Health Science Campus, Toledo, OH, USA
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35
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Abstract
Suprascapular neuropathy has often been overlooked as a source of shoulder pain. The condition may be more common than once thought as it is being diagnosed more frequently. Etiologies for suprascapular neuropathy may include repetitive overhead activities, traction from a rotator cuff tear, and compression from a space-occupying lesion at the suprascapular or spinoglenoid notch. Magnetic resonance imaging is useful for visualizing space-occupying lesions, other pathological entities of the shoulder, and fatty infiltration of the rotator cuff. Electromyography and nerve conduction velocity studies remain the standard for diagnosis of suprascapular neuropathy; however, data on interobserver reliability are limited. Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification; however, open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness. More clinical data are needed to determine if treatment of the primary offending etiology in cases of traction from a rotator cuff tear or compression from a cyst secondary to a labral tear is sufficient or whether concomitant decompression of the nerve is warranted for management of the neuropathy.
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Affiliation(s)
- Robert E Boykin
- Harvard Shoulder Service, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 3200, 3G, Room 3-046, Boston, MA 02114, USA
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Anatomical basis of the vascular risk related to the circumflex scapular artery during posterior approach to the scapula. Surg Radiol Anat 2009; 32:51-4. [DOI: 10.1007/s00276-009-0544-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 08/05/2009] [Indexed: 11/25/2022]
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