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Aslan L, Subasi O, Gedik CC, Birsel O, Lazoglu I, Demirhan M, Eren I. In silico analysis of rib force distribution in postscapulothoracic arthrodesis model. J Orthop Res 2024; 42:942-949. [PMID: 38111178 DOI: 10.1002/jor.25771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
Scapulothoracic arthrodesis (STA) is carried out by fixing the scapula to thoracic ribs which in turn allows the patient suffering from Facioscapulohumeral Muscular Dystrophy to carry out shoulder-joint dependent activities of daily living. A biomechanical analysis of this procedure has not been conducted in the literature and, for the first time, this study investigates the finite element calculated glenohumeral-applied load distributions on ribs by creating a post-STA model. Three loading directions on the glenohumeral joint are designated: anterior-posterior, superior-inferior, and lateral-medial. Reaction forces on the ribs are calculated based on the glenoid force percent. Simulations are repeated by removing a singular rib contact to observe the change in force distributions in the case of missing levels or failed bonding as well as the impact of clavicle osteotomy. Total load distribution is observed highest at T2 followed by T3 and T6. In the T2 missing scenario, total loads on T3 and T4 increase. In the T4 missing case, the most affected level is T3. In the T6 missing scenario, total loads on T5 and T7 increase. In the clavicular osteotomy scenario, all levels' loads increase; the highest is recorded in T7 by 460%, followed by T5, T4, T2, T6, and T3. While all levels contribute to fixation strength, T2 is subjected to the highest loads, and, in the missing level scenarios, the loads are tolerated sufficiently by the remaining levels. Missing T4 scenario has the least effect on the system, which is interpreted as potentially the only skippable level of fixation. Clavicular osteotomy has the highest effect on the arthrodesis site.
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Affiliation(s)
- Lercan Aslan
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Omer Subasi
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Manufacturing and Automation Research Center, Koc University, Istanbul, Turkey
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Ismail Lazoglu
- Manufacturing and Automation Research Center, Koc University, Istanbul, Turkey
| | - Mehmet Demirhan
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Ilker Eren
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
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Ba PA, Schoch B, Werthel JD. Scapulothoracic Fusion Using Multiple Suture Tape Cerclage. Tech Hand Up Extrem Surg 2023; 27:175-181. [PMID: 37073680 DOI: 10.1097/bth.0000000000000434] [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: 04/20/2023]
Abstract
ABSTRACT Scapulothoracic arthrodesis has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy. It was introduced to improve shoulder function. Several methods of fixation have been proposed to obtain the union of the scapula to the ribs. These include plates, screws, cables, or wires with or without bone grafting. The purpose of this manuscript is to describe the surgical technique of scapulothoracic arthrodesis using plate and cerclage suture tapes. LEVEL OF EVIDENCE Level IV, treatment study (case series).
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Affiliation(s)
- Papa Amadou Ba
- Department of Orthopedic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Bradley Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FLA
| | - Jean-David Werthel
- Department of Orthopedic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
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Eren İ, Gedik CC, Kılıç U, Abay B, Birsel O, Demirhan M. Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes. EFORT Open Rev 2022; 7:734-746. [PMID: 36475552 PMCID: PMC9780611 DOI: 10.1530/eor-22-0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition. Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle. There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft. The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores. There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon. In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.
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Affiliation(s)
- İlker Eren
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Cemil Cihad Gedik
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Uğur Kılıç
- Koç University, School of Medicine, Istanbul, Turkey
| | - Berk Abay
- Koç University, School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Demirhan
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Warner WC. Orthopedic Surgery in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Scollan JP, Chughtai M, Evans PJ, Styron JF. Scapulothoracic fusion using nonabsorbable suture fixation: surgical technique and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:118-126. [PMID: 37588150 PMCID: PMC10426597 DOI: 10.1016/j.xrrt.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Historically, scapulothoracic fusion (STF) is performed using steel wire and plate construct fixation. The purpose of this study is to report a recent fusion achieved through ultra-high-molecular-weight polyethylene-reinforced suture fixation as well as to perform a systematic literature review of techniques, fusion rates, complications, and reoperation. Methods Patient data were gathered from chart review and clinical encounters. For the review, MEDLINE, Embase, and Ovid databases were queried for STF cases. Thirty articles reporting on 386 fusion procedures were included. Results Including this patient, 5 of 387 (1.3%) STFs have been attempted with fiber suture. Fusion rates of metal-only constructs is 90.8% (346 of 381) with 11.3% (43 of 381) requiring wire removal or trimming because of symptomatic hardware and 7% (27 of 381) causing a postoperative pneumothorax. Although a small sample size, all fiber-suture constructs have achieved union without implant removal and without pneumothorax development. In this patient, fusion was determined radiographically at 6 months with substantial improvement in pain level and function. Conclusion Scapulothoracic fusion has benefit to patients to have failed other management options for winged scapula, most commonly those with neurologic trauma or facioscapulohumeral muscular dystrophy. With advancements in surgical options, fiber-suture offers an alternative to steel wire to achieve fusion. Further cases with longer term follow-up are needed to determine if significant differences in outcomes exist between constructs.
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Affiliation(s)
- Joseph P. Scollan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter J. Evans
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Cleveland Clinic Martin Health, Stuart, FL, USA
| | - Joseph F. Styron
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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A team approach in the diagnosis and management of facioscapulohumeral muscular dystrophy: a case report. JSES Int 2020; 4:485-490. [PMID: 32939472 PMCID: PMC7479020 DOI: 10.1016/j.jseint.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Boileau P, Pison A, Wilson A, van der Meijden O, Sacconi S, Trojani C, Gauci MO. Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences. J Shoulder Elbow Surg 2020; 29:931-940. [PMID: 31982337 DOI: 10.1016/j.jse.2019.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulothoracic arthrodesis (STA) has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy (FSHD). However, the rate of osseous fusion is variable, and there is a theoretical risk of reduced respiratory function after bilateral STA. METHODS This was a retrospective study of 10 STAs, performed sequentially, in 5 FSHD patients. The surgical technique involved use of a semitubular plate and wire construct with autograft (iliac crest) interposed between the scapula and rib cage. Osseous fusion, respiratory function, and shoulder function were evaluated. The mean follow-up period was 141 ± 67 months (range, 24-225 months). RESULTS Early complications included 1 pneumothorax and 1 pleural effusion. No late complications occurred, and no patients underwent reoperation. On postoperative computed tomography images, complete bony union of the scapula to the ribs was observed in 90% of shoulders (9 of 10). Comparison of preoperative and postoperative pulmonary function test results showed no significant difference in vital capacity (from 87% ± 14% to 85% ± 12%) and forced vital capacity (from 86% ± 16% to 77% ± 15%). Patients gained on average 40° of active forward elevation (from 62° ± 20° to 102° ± 4°) and 22° of abduction (from 58° ± 21° to 89° ± 7°) (P < .001). The mean Subjective Shoulder Value increased from 25% ± 8% to 72% ± 18% (P < .001). All patients were pleased with the results and would recommend the procedure to other persons. CONCLUSION In patients with FSHD, bilateral STA provides satisfactory shoulder function with a high rate of scapulothoracic fusion and few or no significant respiratory repercussions.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France.
| | | | - Adam Wilson
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Olivier van der Meijden
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Sabrina Sacconi
- Department of Neuroscience, Pasteur 2 Hospital, Nice, France
| | - Christophe Trojani
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Marc-Olivier Gauci
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
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Kord D, Liu E, Horner NS, Athwal GS, Khan M, Alolabi B. Outcomes of scapulothoracic fusion in facioscapulohumeral muscular dystrophy: A systematic review. Shoulder Elbow 2020; 12:75-90. [PMID: 32313557 PMCID: PMC7153204 DOI: 10.1177/1758573219866195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/09/2019] [Accepted: 07/05/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Facioscapulohumeral muscular dystrophy (FSHD) is a rare condition associated with selective weakness of the muscles of the upper arm, face, and shoulder girdle, negatively affecting daily activities. Scapulothoracic arthrodesis may restore shoulder function and improve quality of life. The purpose of this review is to evaluate the outcomes and complications of scapulothoracic arthrodesis in FSHD patients. METHODS Medline, Pubmed, and Embase were systematically searched. Studies were included if they described scapulothoracic arthrodesis in FSHD with follow-up, and outcomes were adequately reported. Thirteen eligible articles reported the outcomes of 199 arthrodesis in 130 patients. RESULTS The mean gain of shoulder forward elevation and abduction were 45° (p < 0.05) and 40° (p < 0.05), respectively. There was an overall cosmetic satisfaction and improved performance of daily activities. There is limited and heterogeneous data on changes in pulmonary function, but such changes are clinically insignificant. The rate of complications was 41% of which 10% were serious, requiring an intervention or re-admission. The most common complications were hardware failure (8%), non-union (6%), and pneumothorax (5%). DISCUSSION Scapulothoracic arthrodesis improved cosmesis, performance of daily activities and shoulder motion with no clinically significant loss of pulmonary function. The complication rate is high, and some are potentially serious.
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Affiliation(s)
- Dorsa Kord
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Eva Liu
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | | | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada,Moin Khan, St. Joseph's Healthcare Hamilton, Mary Grace Wing, Room G807, 50 Charlton Ave E., Hamilton L8N 4A6, Ontario, Canada.
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
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Eren İ, Erşen A, Birsel O, Atalar AC, Oflazer P, Demirhan M. Functional Outcomes and Complications Following Scapulothoracic Arthrodesis in Patients with Facioscapulohumeral Dystrophy. J Bone Joint Surg Am 2020; 102:237-244. [PMID: 31658207 DOI: 10.2106/jbjs.19.00571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Facioscapulohumeral dystrophy (FSHD) is an autosomal-dominant myopathy characterized by facial and shoulder girdle muscle weakness with scapular winging. Scapulothoracic arthrodesis is a successful treatment approach for patients with <90° of shoulder elevation. The purpose of the present study was to assess functional outcomes and complications following scapulothoracic arthrodesis in patients with FSHD. METHODS We retrospectively reviewed the records of 40 patients (64 shoulders) in whom scapulothoracic arthrodesis was performed. To achieve fusion, multiple multifilament cables were used together with autologous bone and allograft bone. Preoperative and postoperative shoulder elevation and abduction; Disabilities of the Arm, Shoulder and Hand (Quick version, qDASH) scores; and pulmonary function were compared. Recorded complications were classified as pulmonary or scapular. RESULTS The mean age of the patients at the time of the operation was 25.4 years (range, 15 to 60 years), and the mean duration of follow-up was 71.2 months (range, 12 to 185 months). When the preoperative values were compared with those at the latest follow-up, significant improvement was noted in terms of elevation (from a mean [and standard deviation] of 60.6° ± 17.2° to 123.7° ± 26.7°; p < 0.001), abduction (from 52.7° ± 15.8° to 98.8° ± 20.3°; p < 0.001), and qDASH scores (from 34.7 ± 11.4 to 13.3 ± 13.1; p < 0.001). The overall complication rate was 26.6%. There were 7 pulmonary complications (4 pneumothoraxes, 2 pleural effusions, and 1 major atelectasis), and 5 chest tube placements were required. Ten complications (including 3 rib fractures, 1 brachial plexus palsy, 2 cases of implant irritation, 2 nonunions, 1 delayed union, and 1 scapular fracture) were related to the scapular fixation, and 7 revision procedures were required. Scapulothoracic fusion was achieved in all patients but 1, who had a scapular fracture. Pulmonary function tests were performed for 19 patients, and no difference was observed between preoperative and postoperative results. CONCLUSIONS Scapulothoracic arthrodesis with use of multifilament cables is a successful surgical technique with high fusion rates and low morbidity. Pulmonary complications are common but resolve with careful attention. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- İlker Eren
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopaedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
| | - Ata Can Atalar
- Department of Orthopaedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Piraye Oflazer
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Demirhan
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
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Erşen A, Atalar AC, Bayram S, Demirel M, Tunalı O, Demirhan M. Long-term results of scapulothoracic arthrodesis with multiple cable method for facioscapulohumeral dystrophy: do the results deteriorate over time? Bone Joint J 2018; 100-B:953-956. [PMID: 29954200 DOI: 10.1302/0301-620x.100b7.bjj-2017-1438.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The present study aimed to investigate the long-term functional results of scapulothoracic fusion using multifilament cables in patients with facioscapulohumeral dystrophy (FSHD) to identify if the early improvement from this intervention is maintained. Patients and Methods We retrospectively investigated the long-term outcomes of 13 patients with FSHD (18 shoulders) in whom scapulothoracic fusion using multifilament cables was performed between 2004 and 2007. These patients have previously been reported at a mean of 35.5 months (24 to 87). There were eight men and five women with a mean age of 26 years. Their mean length of follow-up of our current study was 128 months (94 to 185). To evaluate long-term functional results, the range of shoulder flexion and abduction, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with a comparison of preoperatively, interim and at the final outcomes. The fusion was examined radiographically in all. Results The complication rate was 33% (six of 18 scapulothoracic fusions) in 13 patients, which comprised failure of fusion in four shoulders (four patients) all occurring within the first year postoperatively. In two shoulders (one patient) wound problems arose due to attribution from the cables which required shortening but the fusion developed satisfactorily. At the final examination, the mean QuickDASH score and range of movement significantly improved in all but one patient (p < 0.001, p < 0.001 and p < 0.001). In the comparison of 13 patients' mid- and long-term results, the mean QuickDASH score decreased from 9.8 (sd 6.7; 3 to 26) in the third year to 9.1 (sd 5.6; 3 to 22) in the tenth year (p = 0.7); the mean range of shoulder flexion and abduction decreased from 129° (sd 22°; 90° to 160°) and 124° (sd 12; 100° to 150°) at the mid-term to 103° (sd 12°; 80° to 120°) and 101° (sd 8°; 80° to 120°) at the long-term, respectively (p = 0.78 and p = 0.65). Conclusion Scapulothoracic fusion using a multiple cabling method can confer a considerable improvement in clinical and functional outcomes for most patients with FSHD after a long follow-up period. The technique requires careful execution to avoid complications. Cite this article: Bone Joint J 2018;100-B:953-6.
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Affiliation(s)
- A Erşen
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - A C Atalar
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - S Bayram
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - M Demirel
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - O Tunalı
- Department of Orthopedics and Traumatology, Acıbadem University Faculty of Medicine
| | - M Demirhan
- Department of Orthopaedics and Traumatology, KOÇ University School of Medicine, Istanbul, Turkey
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Le Hanneur M, Saint-Cast Y. Long-term results of Letournel scapulothoracic fusion in facioscapulohumeral muscular dystrophy: A retrospective study of eight cases. Orthop Traumatol Surg Res 2017; 103:421-425. [PMID: 28159680 DOI: 10.1016/j.otsr.2016.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to evaluate long-term radio-clinical outcome in scapulothoracic fusion using the Letournel technique (where the fourth rib is passed through the wing of the scapula and cerclage wires are tightened to the two ribs below) for patients suffering from facioscapulohumeral muscular dystrophy (FSHMD), a degenerative pathology affecting scapula-stabilizing muscles, leading to scapular winging, shoulder pain and restricted shoulder abduction and flexion, despite a functional deltoid muscle. METHODS This retrospective study, with an average follow-up of 14 years (168 months; σ=73 months), included four patients who underwent a bilateral procedure, one side after the other, with shoulder abduction and flexion gain as primary endpoints. RESULTS Mean improvement in range of motion was 36° (σ=32°) in abduction and 40° (σ=44°) in flexion. Postoperatively, active abduction averaged 99° (σ=28°) and active flexion 110° (σ=45°). In one case, a 58 year-old patient, gain in motion was 50° for abduction and 60° for anterior elevation. In one patient, range of motion showed bilateral decrease due to the natural course of the FSHMD. No intraoperative complications were reported. DISCUSSION The Letournel technique seems to be an effective long-term solution in FSHMD, without age limit. Improvements appear to be steady over time, the only long-term limitations being the natural course of the disease itself. LEVEL OF EVIDENCE IV - retrospective case series.
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Affiliation(s)
- M Le Hanneur
- Hôpital Robert-Debré, département d'orthopédie pédiatrique, 48, boulevard Sérurier, 75019 Paris, France.
| | - Y Saint-Cast
- Centre de la main, 47, rue de la Foucaudière, 49800 Trélazé, France.
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Atmaca H, Uğur L, Özkan A, Grassi Mantelli A, Erzincanli F. Changes in the loadings on the shoulder girdle in the case of scapulothoracic fusion. Int J Med Robot 2015; 12:538-46. [PMID: 26190477 DOI: 10.1002/rcs.1683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/04/2015] [Accepted: 06/11/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Scapulothoracic fusion (STF) may be an alternative and salvage procedure in the treatment of scapular winging. The biomechanical effects of this procedure on the shoulder girdle have not been previously considered. The purpose of this study is to demonstrate the relationship between STF and the stress distribution pattern of the shoulder girdle. METHODS Three-dimensional solid modeling of the shoulder girdle was carried out using virtual finite element modeling. STF was applied to the reference model obtained in a computer environment. Dynamic and nonlinear analysis was performed. RESULTS Stress distributions in joints and ligaments were calculated. With respect to loading on the joints, maximum equivalent stresses increased on acromioclavicular (AC) and GH joints in the case of STF during abduction and flexion respectively. CONCLUSION Results revealed that STF is a non-physiological, static procedure leading to load increase on GH and AC joint cartilages, which may be a cause of potential joint osteoarthritis. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Halil Atmaca
- Akdeniz University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Antalya, Turkey
| | - Levent Uğur
- Amasya University, Technical Sciences Vocational School, Department of Automative Technology, Amasya, Turkey
| | - Arif Özkan
- Duzce University, Engineering Faculty, Department of Biomedical Engineering, Duzce, Turkey
| | - Alberto Grassi Mantelli
- Medical University of Milan, Istituto Ortopedico Gaetano Pini, Department of Orthopaedic Oncology, Milan, Italy
| | - Fehmi Erzincanli
- Düzce University, Engineering Faculty, Department of Mechanical Engineering, Düzce, Turkey
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Levy O. Thoracoscapular Fusion for Winging of the Scapula with Screw Fixation for Fascioscapulohumeral Dystrophy (Modified Copeland-Howard Procedure). JBJS Essent Surg Tech 2014; 4:e12. [PMID: 30775119 PMCID: PMC6359911 DOI: 10.2106/jbjs.st.m.00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION This article describes our technique of thoracoscapular fusion with screw fixation for treatment of winging of the scapula in patients with fascioscapulohumeral dystrophy. STEP 1 PREOPERATIVE EVALUATION Perform the Horwitz test. STEP 2 POSITION THE PATIENT AND MARK THE SKIN FOR THE OPERATION With the patient on a Montreal mattress, position the arms in 90° to 110° of elevation in the scapular plane and approximately 90° of external rotation and mark the skin. STEP 3 SURGICAL APPROACH Make an incision along the medial scapular edge, incise the trapezius muscle, and detach the levator scapula, rhomboid major, and rhomboid minor muscles. STEP 4 PREPARE THE SCAPULA Do not decorticate the scapula to avoid weakening it. STEP 5 SELECT AND PREPARE THE RIBS Expose three or four ribs subperiosteally, from their superior border to avoid the neurovascular bundle. STEP 6 DRILL THE SCAPULA AND RIBS Drill the ribs with a McDonald dissector underneath them to prevent damage to the pleura. STEP 7 HARVEST AND INTRODUCE BONE GRAFT OR USE BONE-GRAFT SUBSTITUTE AND CLOSE Pack bone chips or bone-graft substitute between the ribs and the deep surface of the scapula. STEP 8 POSTOPERATIVE IMMOBILIZATION AND REHABILITATION An adjustable brace with the arm in 60° of abduction and 30° of forward flexion is worn for three months. RESULTS Between July 1997 and July 2010, a thoracoscapular fusion was performed in thirty-five shoulders of twenty-four patients with fascioscapulohumeral dystrophy15.IndicationsContraindicationsPitfalls & Challenges.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire RG1 5AN, United Kingdom. E-mail address:
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Goel DP, Romanowski JR, Shi LL, Warner JJP. Scapulothoracic fusion: outcomes and complications. J Shoulder Elbow Surg 2014; 23:542-7. [PMID: 24280353 DOI: 10.1016/j.jse.2013.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulothoracic fusion (STF) may be an option to alleviate pain and restore function. The purpose of this study is to report the clinical outcome of patients who underwent STF for the treatment of painful scapular winging. MATERIALS AND METHODS From 1999 through 2008, 10 patients (12 shoulders) underwent an STF for painful winging of the scapula. The mean follow-up period was 41 months (range, 8-72 months). Indications for STF included winging in association with excessive medial and/or lateral clavicular resection and facioscapulohumeral dystrophy, as well as scapular winging related to combined long thoracic and spinal accessory nerve palsy. A retrospective review was performed to evaluate the subjective shoulder value, visual analog scale score, range of motion, unions, and complications. RESULTS There was a statistically significant improvement in the subjective shoulder value, visual analog scale score, range of motion, and satisfaction postoperatively. The overall complication rate was 50% (6 of 12). There were 2 persistent nonunions (2 of 12, 17%), and 50% (6 of 12) of all fusions required subsequent hardware removal because of discomfort. Complications included pleural effusion (3 of 12, 25%), hemopneumothorax (1 of 12, 8%) pulmonary embolus (1 of 12, 8%), and infection (1 of 12, 8%). With the exception of the revision nonunion, all complications resolved with no negative sequelae. CONCLUSION STF results in improved function and pain relief. STF is associated with a high short-term complication rate with limited long-term sequelae.
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Affiliation(s)
- Danny P Goel
- Division of Arthroscopic, Reconstructive Surgery and Joint Preservation, UBC Department of Orthopedics, Burnaby, BC, Canada
| | | | - Lewis L Shi
- Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA, USA
| | - Jon J P Warner
- Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA, USA.
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Cooney AD, Gill I, Stuart PR. The outcome of scapulothoracic arthrodesis using cerclage wires, plates, and allograft for facioscapulohumeral dystrophy. J Shoulder Elbow Surg 2014; 23:e8-13. [PMID: 23790678 DOI: 10.1016/j.jse.2013.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/13/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulothoracic arthrodesis is a recognized treatment for impaired shoulder function in patients with facioscapulohumeral dystrophy (FSHD) and is traditionally performed with autograft. The purpose of the study was to report our experience with scapulothoracic arthrodesis in patients with FSHD using allograft, rather than autograft, with particular respect to the effect of fusion on preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores; forced vital capacity (FVC); and complications. MATERIALS AND METHODS The early results of 14 consecutive scapulothoracic arthrodeses in FSHD patients with cerclage wires, plates, and allograft (fresh-frozen femoral heads) are reported. DASH scores were recorded preoperatively and 6 months postoperatively. Preoperative and 6-month FVCs were compared. The surgical technique is described. RESULTS Eleven patients underwent 14 fusions. The mean follow-up period was 29 months (range, 6-50 months). Forward flexion improved from 70° to 115° (P = .001) and abduction from 68° to 109° (P = .007). The DASH score improved from 48 points to 34 points (P = .005). FVC decreased from 98% to 92% of predicted (P = .021), although this was not clinically significant. One patient required revision for nonunion, and metalwork was removed in 5 scapulae. A postoperative chest infection developed in 1 patient and a pleural effusion in another. One brachial plexus palsy occurred, which had almost completely resolved by 27 months postoperatively. CONCLUSION Scapulothoracic arthrodesis can be performed successfully with allograft. The nonunion and complication rates are similar to those in the existing literature. A small decrease in FVC does occur but not to a clinically significant level.
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Affiliation(s)
- Alan D Cooney
- Department of Orthopaedics and Trauma, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Inder Gill
- Department of Orthopaedics and Trauma, Freeman Hospital, Newcastle upon Tyne, UK
| | - Paul R Stuart
- Department of Orthopaedics and Trauma, Freeman Hospital, Newcastle upon Tyne, UK
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Sewell MD, Higgs DS, Al-Hadithy N, Falworth M, Bayley I, Lambert SM. The outcome of scapulothoracic fusion for painful winging of the scapula in dystrophic and non-dystrophic conditions. ACTA ACUST UNITED AC 2012; 94:1253-9. [DOI: 10.1302/0301-620x.94b9.29402] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Scapulothoracic fusion (STF) for painful winging of the scapula in neuromuscular disorders can provide effective pain relief and functional improvement, but there is little information comparing outcomes between patients with dystrophic and non-dystrophic conditions. We performed a retrospective review of 42 STFs in 34 patients with dystrophic and non-dystrophic conditions using a multifilament trans-scapular, subcostal cable technique supported by a dorsal one-third semi-tubular plate. There were 16 males and 18 females with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0 years (2.0 to 10.6). The mean Oxford shoulder score improved from 20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions had lower overall functional scores but achieved greater improvements following STF. The mean active forward elevation increased from 59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10° to 90°) to 83° (30° to 130°) with a greater range of movement achieved in the dystrophic group. Revision fusion for nonunion was undertaken in five patients at a mean time of 17 months (7 to 31) and two required revision for fracture. There were three pneumothoraces, two rib fractures, three pleural effusions and six nonunions. The main risk factors for nonunion were smoking, age and previous shoulder girdle surgery. STF is a salvage procedure that can provide good patient satisfaction in 82% of patients with both dystrophic and non-dystrophic pathologies, but there was a relatively high failure rate (26%) when poor outcomes were analysed. Overall function was better in patients with dystrophic conditions which correlated with better range of movement; however, patients with non-dystrophic conditions achieved greater functional improvement.
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Affiliation(s)
- M. D. Sewell
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - D. S. Higgs
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - N. Al-Hadithy
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - M. Falworth
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - I. Bayley
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - S. M. Lambert
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
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Demirhan M, Uysal O, Atalar AC, Kilicoglu O, Serdaroglu P. Scapulothoracic arthrodesis in facioscapulohumeral dystrophy with multifilament cable. Clin Orthop Relat Res 2009; 467:2090-7. [PMID: 19333668 PMCID: PMC2706357 DOI: 10.1007/s11999-009-0815-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 03/13/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Patients with facioscapulohumeral dystrophy (FSHD) are affected mostly by impaired shoulder function. Scapulothoracic arthrodesis was introduced to improve shoulder function. We evaluated the outcomes of scapulothoracic arthrodesis using multifilament cables, performed on 13 patients with FSHD (18 shoulders). There were eight males and five females (mean age, 29 years; range, 20-50 years). Outcome criteria were active shoulder forward flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, respiratory function tests, and a new shoulder function score. Patients were followed for a minimum of 24 months (average, 35.5 months; range, 24-87 months). Solid fusion was obtained in all shoulders (two after revision); active abduction range increased from 47.2 degrees +/- 11.6 degrees to 102.2 degrees +/- 10.0 degrees (mean +/- standard deviation) and anterior flexion range from 55.6 degrees +/- 16.1 degrees to 126.1 degrees +/- 20.9 degrees . The DASH score decreased from 33.6 +/- 8.9 points preoperatively to 11.6 +/- 8.0 points postoperatively. Shoulder function score increased from 15.9 +/- 2.4 points to 22.2 +/- 1.3 points. Scapulothoracic arthrodesis provides satisfactory function in patients with FSHD. Our data suggest use of multifilament cables for fixation is a reasonable option with an acceptable complication rate. LEVEL OF EVIDENCE Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mehmet Demirhan
- Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Ozgur Uysal
- Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Ata Can Atalar
- Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Onder Kilicoglu
- Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Piraye Serdaroglu
- Department of Neurology, Neuromuscular Unit, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Falcone MO, Sauvage A, Wavreille G, Tiffreau V, Fontaine C, Chantelot C. Consolidation et fonction après huit arthrodèses scapulothoraciques. ACTA ACUST UNITED AC 2008; 94:649-58. [DOI: 10.1016/j.rco.2008.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
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Elhassan B, Chung ST, Ozbaydar M, Diller D, Warner JJP. Scapulothoracic fusion for clavicular insufficiency. A report of two cases. J Bone Joint Surg Am 2008; 90:875-80. [PMID: 18381326 DOI: 10.2106/jbjs.g.00986] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Bassem Elhassan
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Giannini S, Faldini C, Pagkrati S, Grandi G, Digennaro V, Luciani D, Merlini L. Fixation of winged scapula in facioscapulohumeral muscular dystrophy. Clin Med Res 2007; 5:155-62. [PMID: 18056023 PMCID: PMC2111408 DOI: 10.3121/cmr.2007.736] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To verify if stabilizing the scapulothoracic joint without arthrodesis could lead to functional improvement of shoulder range of motion and clinical improvement of winged scapula, we incorporated four additional patients into our previous analysis to determine if the results obtained were long lasting, and to compare this fixation with the other techniques described in the literature, balancing the benefits with the complications. DESIGN A retrospective study. PARTICIPANTS Thirteen patients with bilateral winged scapula affected by facioscapulohumeral muscular dystrophy. Nine of these patients had been analyzed in our previous study. METHODS Patients were operated on by bilateral fixing of the scapula to the rib cage using metal wires without arthrodesis (scapulopexy). RESULTS All patients experienced improvement in active range of motion of the shoulder and all of them had clinical improvement with complete resolution of the winged scapula. In all twenty-six surgical interventions of scapulopexy, a stable and long-lasting fixation of the scapula to the rib cage was achieved. The complications strictly associated to the surgical technique encountered were one pneumothorax, which was resolved spontaneously, and one wire breakage without trauma. Average follow-up was 10 years (range, 3 to 18 years). CONCLUSION The scapulopexy used in this extended series of patients consisted of repositioning the scapula and fixing it to four ribs by using metal wires without performing arthrodesis. This technique has a low rate of complications, is reproducible, safe and effective, resulting in clinical and functional improvement.
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Affiliation(s)
- Sandro Giannini
- Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy.
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Giannini S, Ceccarelli F, Faldini C, Pagkrati S, Merlini L. Scapulopexy of winged scapula secondary to facioscapulohumeral muscular dystrophy. Clin Orthop Relat Res 2006; 449:288-94. [PMID: 16672903 DOI: 10.1097/01.blo.0000218735.46376.c0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Facioscapulohumeral muscular dystrophy is an hereditary disease that causes weakness of the scapulothoracic muscles and leads to winged scapula. Patients with facioscapulohumeral muscular dystrophy are unable to sustain shoulder abduction or flexion and are limited in daily activities. We retrospectively reviewed nine patients (18 procedures) who had scapulothoracic fixation without arthrodesis (scapulopexy). The technique consists of repositioning the scapula over the rib cage and fixation to four ribs with metal wires. We assessed improvement in range of motion of the shoulder, maintenance of the correction with time, and cosmetic and functional results. The average age of the patients at surgery was 25.2 years (range, 15-35 years), and there were no major complications. The average followup was 9.9 years (range, 3-16 years). All patients had complete resolution of the winged scapula and improved range of motion. Arm abduction increased from an average of 68.3 degrees (range, 45 degrees-90 degrees) preoperatively to 96.1 degrees (range, 60 degrees-120 degrees) postoperatively. Arm flexion increased from an average of 57.2 degrees (range, 45 degrees-90 degrees) preoperatively to 116.1 degrees (range, 80 degrees-180 degrees) postoperatively. The position of the scapula obtained by surgery was maintained with time, and the patients had satisfactory cosmetic results. LEVEL OF EVIDENCE Therapeutic study, Level IV. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sandro Giannini
- Orthopaedic Department, University of Bologna, Istituto Ortopedico Rizzoli, Rizzoli, Italy.
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Rhee YG, Ha JH. Long-term results of scapulothoracic arthrodesis of facioscapulohumeral muscular dystrophy. J Shoulder Elbow Surg 2006; 15:445-50. [PMID: 16831649 DOI: 10.1016/j.jse.2005.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 10/11/2005] [Indexed: 02/01/2023]
Abstract
Many patients with facioscapulohumeral muscular dystrophy eventually have instability of the scapula resulting from weakness of the scapula stabilizers. A subset of patients, however, has sufficient strength in the supraspinatus and deltoid muscles to flex and abduct the arm, if the scapula has been stabilized. The purpose of this study is to report the clinical results of six patients (9 shoulders) that underwent scapulothoracic arthrodesis for the treatment of limited shoulder motion and scapular winging caused by facioscapulohumeral muscular dystrophy. The average preoperative active flexion was 71 degrees , which improved to 109 degrees at the last follow-up. The UCLA Shoulder Score also rose from 18.4 points to 27.9 points at the last follow-up. All patients did well in activities of daily living after the procedure. Scapulothoracic arthrodesis is considered a successful treatment method for facioscapulohumeral muscular dystrophy, as it improves appearance, function, and tolerance to exercise.
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Affiliation(s)
- Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Abstract
Facioscapulohumeral muscular dystrophy is a commonly occurring myopathy that affects the facial and periscapular musculature. We describe a case in a high school throwing athlete that presented as shoulder pain with throwing a baseball. The patient has begun an intensive physical therapy training program that targets his weak scapular stabilizers as well as altering his throwing mechanics. His symptoms have improved, and he is able to continue competing in throwing sports at a high level.
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Affiliation(s)
- Scott Kaar
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Scapulothoracic Arthrodesis: Indications and Surgical Technique. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2005. [DOI: 10.1097/01.bte.0000174701.92629.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeon IH, Neumann L, Wallace WA. Scapulothoracic fusion for painful winging of the scapula in nondystrophic patients. J Shoulder Elbow Surg 2005; 14:400-6. [PMID: 16015240 DOI: 10.1016/j.jse.2004.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A modified technique of scapulothoracic fusion was used in 6 patients who did not have muscular dystrophy and who were later evaluated clinically. The cause of the painful winging of the scapula was traumatic disruption of the trapezius and the accessory nerve in 3 patients, injury to the brachial plexus in 2, and Sprengel's deformity in 1. To obtain fusion, double wires were passed around each of 4 ribs. A Rush pin was then contoured to fit the curvature of the scapula, and the wires were passed through the scapula and tied over the Rush pin with bone graft. The mean age of the patients was 30 years (range, 22-39 years), with a mean follow-up of 49 months. The mean increase in elevation was 18 degrees with significant pain relief. The medium-term results showed that this operation was successful in achieving stability of the scapula while improving pain and function in patients without facioscapulohumeral dystrophy.
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Affiliation(s)
- In-Ho Jeon
- Nottingham Shoulder and Elbow Unit, Nottingham City Hospital, United Kingdom
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Abstract
This article focuses on the rehabilitation considerations for several shoulder surgeries: acromioplasty, rotator cuff repair, rotator cuff debridement, Bankart repair, thermal capsulorrhaphy, superior labral anterior posterior repair, multidirectional instability, proximal humerus fracture, surgical management of the stiff shoulder, arthroplasty,and fusion. General guidelines are presented for discussing and planning rehabilitation for patients, including exercises, timing of progression, patient education, precautions or restrictions, and expectations.
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Affiliation(s)
- Sarah Jackins
- University of Washington Medical Center, 4245 Roosevelt Way NE, Seattle, WA 98195, USA.
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