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Deshmukh A, Shevate I, Salunkhe R, Gupta A, Chopra S. An Unusual Pattern of Scapular Avulsion Fracture in the Spine: A Case Study. Cureus 2024; 16:e62132. [PMID: 38993457 PMCID: PMC11238760 DOI: 10.7759/cureus.62132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Acromion fractures, particularly isolated cases, are uncommon but significant in shoulder injuries. There is no universally accepted treatment protocol, but the classification of the fracture helps to guide clinical decisions. We present a case report aiming to contribute to the understanding of treatment options for acromion fractures. A 22-year-old male sustained a left shoulder injury during a wrestling match, resulting in a type 2 acromion fracture. Conservative treatment was initiated with regular follow-ups. Serial imaging showed no further displacement. Gradual rehabilitation exercises were introduced based on healing progress. The rarity of isolated acromion fractures complicates their management. Conservative management, coupled with rehabilitation exercises, yielded positive outcomes in our case, suggesting its efficacy as a primary treatment option for isolated displaced acromion fractures. Further research is needed to establish standardized protocols for managing such fractures, but until then, conservative care remains a viable approach, potentially preferred over surgical intervention.
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Affiliation(s)
- Ashwin Deshmukh
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND
| | - Ishan Shevate
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND
| | - Rahul Salunkhe
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND
| | - Archit Gupta
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND
| | - Shubhankar Chopra
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND
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Stammer AT, Saxena P, Dekker AP, Ashwood N. Glenoid Fracture Fixation Using an Acu-Loc Distal Radius Plate. Cureus 2024; 16:e60751. [PMID: 38903285 PMCID: PMC11188009 DOI: 10.7759/cureus.60751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Displaced fractures of the glenoid require surgical fixation. This poses multiple problems, including a difficult approach and achieving adequate reduction with current implants. We provide a surgical technical tip for fixing scapula neck and glenoid rim fractures with an Acu-Loc distal radius plate (Acumed, Weyhill, UK), illustrated with two recent case reports. Here, we present two cases of a 58-year-old female and a 51-year-old male presenting to a hospital following a fall, both sustaining an isolated right glenoid intra-articular fracture evident on plain radiographs. CT scans revealed a displaced and fragmented glenoid surface. A reverse Judet posterior approach facilitated exposure to enable the reduction of the glenoid, an uncommon approach. Current plate designs provide surgeons with limited options to fix complex fractures of the scapula and were not suitable here. The lateral scapula border and inferior glenoid have a similar anatomical shape to the distal radius. An Acu-Loc locking distal radius plate with a radial styloid plate was trialled and provided a good reduction to the fragmented glenoid. A distal radius plate can be a useful option to consider in complex scapula neck and glenoid rim fractures. A better understanding of glenoid shape will facilitate the further development of orthopaedic implants. Familiarity with various surgical approaches is needed to operate on these complex fractures.
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Affiliation(s)
- Adam T Stammer
- Orthopaedic Surgery, Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
| | - Prateek Saxena
- Orthopaedic Surgery, Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
| | - Andrew P Dekker
- Trauma and Orthopaedic Surgery, Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
| | - Neil Ashwood
- Trauma & Orthopaedics, University Hospitals Derby and Burton, Derby, GBR
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Schmidt V, Mukka S, Bergdahl C, Ekholm C, Brüggemann A, Wolf O. Epidemiology, treatment, and mortality of 3973 scapula fractures from the Swedish fracture register. J Shoulder Elbow Surg 2024:S1058-2746(24)00305-7. [PMID: 38688421 DOI: 10.1016/j.jse.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Scapula fractures are relatively uncommon, accounting for <1% of all fractures and approximately 3%-5% of shoulder girdle fractures. This study comprehensively describes the epidemiology, fracture classification, treatment, and mortality associated with scapula fractures within a large adult Swedish population. METHODS This observational study included all patients ≥ 18 years old at the time of injury with a scapula fracture (ICD S42.1) registered in the Swedish Fracture Register between March 2011 and June 2020. Variables studied were age, sex, and injury mechanism, including energy level, fracture classification, associated fractures, treatment, and mortality. RESULTS We included 3930 patients (mean age 58 years, standard deviation 18, 64% men) with 3973 scapula fractures. Some 22% of the fractures were caused by high-energy trauma and 21% had at least 1 associated fracture. High energy-injuries were most common in glenoid neck (44%) and scapular body (35%) fractures. However, same-level falls were the most common cause of glenoid rim (62%) and intra-articular glenoid (55%) fractures. Clavicle fractures (9%) and proximal humerus fractures (5%) were the most commonly associated fractures. The most common fracture types were the glenoid rim (n = 1289, 32%) and scapular body (n = 1098, 28%) fractures. Nonoperative treatment was performed in 81% of patients. Glenoid rim and intra-articular glenoid fractures were treated operatively in over 30% of cases. The mortality rate for the whole cohort was 4% at 1 year. CONCLUSIONS Scapula fractures are predominately sustained by men. High energetic injuries and associated fractures are present in 1 in five patients. Nonoperative treatment is chosen in 4 of five patients, but for some fracture types 1 in 3 undergo surgery.
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Affiliation(s)
- Viktor Schmidt
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Ekholm
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Brüggemann
- Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden
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Chalidis B, Papadopoulos PP, Papadopoulos P, Pitsilos C. The Role of Arthroscopy in Contemporary Glenoid Fossa Fracture Fixation. Diagnostics (Basel) 2024; 14:908. [PMID: 38732322 PMCID: PMC11083719 DOI: 10.3390/diagnostics14090908] [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: 03/15/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Glenoid fossa fractures are rare injuries accounting for 10 to 29% of all intra-articular scapula fractures. They are usually the result of high-energy trauma, and concomitant injuries are not uncommon. Patients with glenoid fractures are admitted with shoulder pain and restricted range of motion. Although shoulder plain radiographs could establish the diagnosis, a computed tomography scan is necessary to adequately define the fracture pattern and characteristics. The most commonly used classification system is that of Ideberg (modified by Goss), which includes five glenoid fossa fracture types according to the location, extension, and complexity of the lesion. Articular surface displacement and step-off are the most important factors that should be taken under consideration when deciding for conservative or surgical management. Operative treatment includes open reduction and internal fixation through a posterior or anterior approach depending on fracture morphology and displacement. However, open surgical techniques are related to extensive soft-tissue disruption, risk of neurovascular injury, and inadequate exposure of the entire glenoid cavity. Introduction of arthroscopy could facilitate better visualization of the glenoid articular surface and improved fracture reduction. However, it is a technically demanding procedure with many challenges and pitfalls. The aim of this review is to summarize the current evidence regarding the treatment of glenoid fossa fractures and present the beneficial effect of arthroscopy in improving the quality of fracture fixation and overall functional outcomes.
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Affiliation(s)
- Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Polychronis P. Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
| | - Charalampos Pitsilos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.P.); (P.P.); (C.P.)
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Flaaten N, Moslim H, Tang E, Varrall R. Scapular fractures: A regional and rural perspective. Aust J Rural Health 2024; 32:388-393. [PMID: 38480988 DOI: 10.1111/ajr.13100] [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: 08/23/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective. OBJECTIVE The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre. DESIGN The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries. FINDINGS One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma. DISCUSSION A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world. CONCLUSION Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.
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Affiliation(s)
- Nordan Flaaten
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopedic Department, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Huissan Moslim
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Eric Tang
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Ruth Varrall
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
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Mavrotas J, Fischer J. Scapula fractures: functional anatomy, clinical assessment and management. Br J Hosp Med (Lond) 2024; 85:1-8. [PMID: 38557096 DOI: 10.12968/hmed.2023.0351] [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] [Indexed: 04/04/2024]
Abstract
Fractures of the scapula are rare injuries, accounting for 3-5% of all shoulder girdle fractures. They are frequently the result of high energy trauma and often present with concurrent and life-threatening injuries to adjacent structures, leading to significant morbidity and mortality. Patients presenting with scapula fractures must receive a thorough and systematic clinical assessment as directed by national trauma guidelines. Appropriate imaging is essential in delineating fracture morphology and should at the very least include anteroposterior, anteroposterior oblique (Grashey) and axillary or scapula 'Y' view of the shoulder. Computed tomography imaging with three-dimensional reconstruction allows better delineation of the fracture morphology and helps with surgical planning. A lack of randomised controlled trials comparing the efficacy of conservative and operative management of scapula fractures has resulted in limited consensus for surgical indications. Nevertheless, most extra-articular fractures can be managed conservatively while intra-articular fractures of the glenoid frequently require surgical fixation.
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Affiliation(s)
- Jason Mavrotas
- Department of Orthopaedics, Macclesfield District General Hospital, East Cheshire NHS Trust, Macclesfield, UK
| | - Jochen Fischer
- Department of Orthopaedics, Macclesfield District General Hospital, East Cheshire NHS Trust, Macclesfield, UK
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Cole PA, Schroder LK, Brahme IS, Thomas CN, Kuhn L, Zaehringer E, Petersik A. Three-Dimensional Mapping of Scapular Body, Neck, and Glenoid Fractures. J Orthop Trauma 2024; 38:e48-e54. [PMID: 38031277 DOI: 10.1097/bot.0000000000002734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES The purpose of this study was to report patterns of scapular fractures and define them with a contemporary methodology. METHODS . DESIGN Retrospective study, 2015-2021. SETTING Single, academic, Level 1 trauma center. PATIENT SELECTION CRITERIA Consecutive patients ≥18 years, presenting with unilateral scapula fracture, with thin-slice (≤0.5-mm) bilateral computed tomography (CT) scans of the entirety of both the injured and uninjured scapulae. OUTCOME MEASURES AND COMPARISONS Thin-slice (0.5-mm) CT scans of injured and normal scapulae were obtained to create three-dimensional (3D) virtual models. 3D modeling software (Stryker Orthopedics Modeling and Analytics, Stryker Trauma GmbH, Kiel, Germany aka SOMA) was used to create a 3D map of fracture location and frequency. Fracture zones were delineated using anatomic landmarks to characterize fracture patterns. RESULTS Eighty-seven patients were identified with 75 (86%) extra-articular and 12 (14%) intra-articular fractures. The dominant fracture pattern emanated from the superior lateral border (zone E) to an area inferior to the spinomedial angle (zone B) and was present in 80% of extra-articular fractures. A second-most common fracture line propagated from the primary (most-common) line toward the inferior medial scapular border with a frequency of 36%. Bare zones (with 1 or no fractures present) were identified in 4 unique areas. Furthermore, intra-articular fractures were found to be heterogenous. CONCLUSIONS The 3D fracture map created in this study confirmed that extra-articular scapular fractures occur in certain patterns with a relatively high frequency. Results provide greater insight into scapular fracture locations and may help to study prognosis of injury and improve treatment strategy including operative approaches and surgical tactics.
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Affiliation(s)
- Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- HealthPartners Orthopaedics & Sports Medicine, Bloomington, MN
| | - Lisa K Schroder
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
| | - Indraneel S Brahme
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
| | - Claire N Thomas
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
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Nakagawa S, Hirose T, Hanai H, Tsunematsu T, Ohori T, Yokoi H, Uchida R. Unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability. J Orthop Sci 2024; 29:122-127. [PMID: 36402605 DOI: 10.1016/j.jos.2022.10.021] [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: 05/19/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of the present study was to investigate the characteristics of unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability. METHODS Participants were 38 patients, who had complaints of instability on only one side (symptomatic shoulder) and had no complaints despite of a glenoid fracture on the other shoulder (asymptomatic shoulder) from 2011 to 2020. Factors that could influence the onset of symptoms including glenoid rim morphology were retrospectively investigated. RESULTS Among the asymptomatic shoulders, 16 had a single traumatic event and 22 had no history of trauma. The glenoid morphology was normal in 6, erosion in 12 and bony Bankart in 20 on the symptomatic side, whereas the respective shoulders were 0, 16 and 22 on the asymptomatic side. Bone union of bony Bankart was complete in 9, partial in 3 and non-union in 8 on the symptomatic side, whereas the respective shoulders were 18, 3 and 1 on the asymptomatic side. The mean glenoid defect size was 10.4% and 7.8%, and the mean bone fragment size was 5.0% and 4.5%, respectively. The mean medial displacement of bone fragments was 2.6 mm and 1.0 mm, respectively (p < 0.001). A larger glenoid defect (≥10%) was recognized in 19 symptomatic shoulders and 10 asymptomatic shoulders. Among them, erosion was solely recognized in 5 symptomatic shoulders. In shoulders with bony Bankart, all 10 asymptomatic shoulders had a completely or partially united fragment with less than 2 mm displacement. On the other hand, among 14 symptomatic shoulders, united fragment was solely recognized in 8 shoulders, in which medial displacement was less than 2 mm in 3 shoulders. CONCLUSIONS Even if a glenoid fracture occurred, symptom such as instability or pain was not always recognized by all patients. Regardless of glenoid defect size, shoulders with a completely or partially united bone fragment and with less than 2 mm displacement were found to be asymptomatic.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Toshitaka Tsunematsu
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
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Lehmann LJ, Schmalzl J. [Scapular fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:69-78. [PMID: 38175216 DOI: 10.1007/s00113-023-01397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
Scapular fractures are rare injuries that require different treatment strategies. Nondisplaced fractures and the majority of scapular body fractures can be treated conservatively, while surgical treatment should be considered for displaced fractures involving the glenoid. Displaced glenoid fractures of appropriate size and intra-articular step formation should be treated surgically. Different classification systems for scapular fractures can support the treatment decision. Postoperative and posttraumatic management should include early mobilization to achieve a good functional outcome. Clear recommendations and treatment algorithms at the evidence level are not available and long-term outcomes of scapular fractures are the subject of further investigation. The results published so far show good to excellent results for surgical and conservative treatment, depending on the type of fracture. Individual patient factors should be considered when planning treatment.
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Affiliation(s)
- L-J Lehmann
- Klinik für Unfall‑, Handchirurgie und Sportmedizin, ViDia Kliniken Karlsruhe, Steinhäuserstr. 18, 76135, Karlsruhe, Deutschland.
| | - J Schmalzl
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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Saiz AM, Mayer R, Kellam PJ, Schultz BJ, Cunningham B, Warner SJ, Choo A. Distractor Application and Dry Arthroscopy to Improve Articular Visualization During Scapula Fracture Surgery Via a Posterior Approach. J Orthop Trauma 2023; 37:e447-e451. [PMID: 36728980 DOI: 10.1097/bot.0000000000002550] [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: 12/09/2022] [Indexed: 02/03/2023]
Abstract
SUMMARY Intra-articular glenoid displacement is an indication for open reduction and internal fixation of scapular fractures. However, direct visualization of the glenoid is limited, and articular reductions are typically performed and assessed using extra-articular cortical reduction reads and fluoroscopic imaging. In this technique, we describe the application of a distractor for direct visualization of the glenoid articular surface. In this way, anatomic reduction of the glenoid articular surface can be assessed and achieved. In addition, we discuss the use of a portable, dry arthroscopy when needed. This technique has resulted in good-to-excellent articular reductions by adjusting extra-articular reads that seemed adequate before intra-articular visualization. This technique is safe, requires minimal extra set-up or instruments, and results in good-to-excellent articular reductions.
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Affiliation(s)
- Augustine M Saiz
- Department of Orthopaedic Surgery, University of Texas Health Science Center Houston, Houston, TX
- Department of Orthopaedic Surgery, UC Davis Health, Sacramento, CA; and
| | - Ryan Mayer
- Department of Orthopaedic Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Patrick J Kellam
- Department of Orthopaedic Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Blake J Schultz
- Department of Orthopaedic Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Bryce Cunningham
- Department of Orthopaedic Surgery, Erlanger Health System, Chattanooga, TN
| | - Stephen J Warner
- Department of Orthopaedic Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Andrew Choo
- Department of Orthopaedic Surgery, University of Texas Health Science Center Houston, Houston, TX
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Sweeney BM, Sadhwani SD, Kendall MS, Kelly MJ. Treatment of coronal split glenoid fracture utilizing open reduction internal fixation with immediate intraoperative conversion to rTSA: a novel approach. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:534-539. [PMID: 37928997 PMCID: PMC10625000 DOI: 10.1016/j.xrrt.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Brendan M. Sweeney
- Orthopedic Surgery Residency, UPMC Central Pa., Harrisburg Campus, Harrisburg, PA, USA
| | - Shaan D. Sadhwani
- Orthopedic Surgery Residency, UPMC Central Pa., Harrisburg Campus, Harrisburg, PA, USA
| | - Matthew S. Kendall
- Orthopedic Surgery Residency, UPMC Central Pa., Harrisburg Campus, Harrisburg, PA, USA
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12
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Spagna G, Boehm E, Lorenz C, Moroder P, Scheibel M. [Treatment strategies for traumatic anterior shoulder dislocation]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00113-023-01340-x. [PMID: 37341735 DOI: 10.1007/s00113-023-01340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/22/2023]
Abstract
Anterior glenohumeral instability is the most frequent type of shoulder instability. This is often associated with labral and osseous lesions leading to recurrent instability. A detailed medical history, a physical examination and targeted diagnostic imaging are necessary to assess possible pathological soft tissue alterations as well as bony lesions of the humeral head and the glenoid bone. Early surgical treatment has been shown to reduce the risk of recurrence, especially in young active athletes, and can avoid secondary damage. Shoulder dislocations in older patients also require a detailed assessment and selection of treatment as persisting pain and limitation of movement can occur due to rotator cuff lesions and nerve injuries. The purpose of this article is to provide an overview of the currently available evidence and results regarding diagnostic considerations and conservative vs. surgical treatment and time to return to sport after treatment of a primary anterior shoulder dislocation.
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Affiliation(s)
- Giovanni Spagna
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz.
| | - Elisabeth Boehm
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Christina Lorenz
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Philipp Moroder
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Markus Scheibel
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité-Universitätsmedizin Berlin, Berlin, Deutschland
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13
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Tenfelde O, Karwatzke A, Kappel P, Balke M, Wafaisade A. [Management of a multifragmentary glenoid fracture : Case report of a two-stage surgical procedure]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:419-422. [PMID: 35833977 PMCID: PMC10160182 DOI: 10.1007/s00113-022-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 05/05/2023]
Abstract
This article describes a multifragmentary glenoid fracture in a 65-year-old patient after falling from a height of 2 m. The accident led to complete Y‑shaped destruction of the glenohumeral joint with a large posteroinferior fragment and a large anteroinferior glenoid fragment. The treatment consisted of a two-stage surgical procedure and a combination of open and arthroscopic techniques. First, open surgery of one fragment from the dorsal side was performed using screw osteosynthesis. Arthroscopic refixation of the anterior glenoid fragment (bony Bankart lesion) followed 4 weeks later using a guided Endobutton® technique (Smith & Nephew). Ideberg type 6 multifragmentary glenoid fractures are rare and should be treated surgically, especially with dislocated fragments, instability in the glenohumeral joint and in younger patients. Given the lack of evidence in the literature, individual surgical strategies are necessary.
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Affiliation(s)
- Oliver Tenfelde
- Lehrstuhl für Unfallchirurgie, Orthopädie und Sporttraumatologie, Universitätsklinik Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland
- Sportsclinic Cologne, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - Andreas Karwatzke
- Lehrstuhl für Unfallchirurgie, Orthopädie und Sporttraumatologie, Universitätsklinik Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - Paola Kappel
- Lehrstuhl für Unfallchirurgie, Orthopädie und Sporttraumatologie, Universitätsklinik Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - Maurice Balke
- Lehrstuhl für Unfallchirurgie, Orthopädie und Sporttraumatologie, Universitätsklinik Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland
- Sportsclinic Cologne, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - Arasch Wafaisade
- Lehrstuhl für Unfallchirurgie, Orthopädie und Sporttraumatologie, Universitätsklinik Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
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14
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Giordano V, Pires RE, Labronici PJ, Vieira I, de Souza FS, Sassine TJ, Mendes AF, Freitas A. Open reduction and internal fixation of Ideberg type IA glenoid fractures: Tricks, pearls, and potential pitfalls based on a retrospective cohort of 33 patients focusing on the rehabilitation protocol. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:571-580. [PMID: 36094673 DOI: 10.1007/s00590-022-03389-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim is to describe the surgical steps for ORIF of anterior and anteroinferior glenoid rim fractures using the anterior axillary approach, describing the tricks, pearls, and pitfalls of this surgical technique. METHODS A retrospective cohort of skeletally mature patients treated for an anterior glenoid rim fracture carrying > 20% of the glenoid fossa during a 10-year period were operated on using a vertical axillary incision, osteosynthesis with 2.0-mm cortical screws, and labral repair with small diameter metallic anchors and non-absorbable sutures. Rehabilitation began on the first postoperative day, including passive external rotation exercises and active-assisted flexion, adduction, and abduction exercises as tolerated. The exercises are performed with the patient sitting or lying down. Phase 1 is continued for 6-10 weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10 weeks, the fracture and labrum are healed, so phase 2 rehabilitation begins with strengthening and ROM exercises. Radiologic and clinical outcomes, including active range of motion (ROM), glenohumeral stability, and visual analogue scale (VAS) were measured. RESULTS About 33 patients (35 fractures) had complete medical records and pre- and post-operative imaging exams available for further analysis regarding the surgical protocol, with a mean of 4.8 years. The mean DASH questionnaire was 3.75 ± 9.0 and the mean CM score was 62.5 ± 0.1. Active flexion and internal rotation were recovered in all patients, while external rotation presented an average loss of 8° (p = 0.12) and abduction of 5° (p = 0.33). The mean VAS was 1.1 ± 0.8. No patient reported major or disabling symptoms, or great difficulty or inability to perform daily or recreational activities. No patient presented residual instability of the glenohumeral joint. CONCLUSION In this retrospective cohort, ORIF using a vertical axillary incision, osteosynthesis with 2.0-mm screws, and labral repair with small diameter metallic anchors and non-absorbable sutures was a safe approach, with a minimal risk of complications and residual instability. The accelerated postoperative rehabilitation protocol, allowing immediate passive external rotation of the operated shoulder, resulted in a non-significant loss of ROM compared to the contralateral side. Therefore, we recommend this management strategy for anterior glenoid rim fractures in patients with unstable shoulder joint after traumatic glenohumeral dislocation. LEVEL OF EVIDENCE IV Therapeutic Study (Surgical technique and Retrospective cohort).
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil.
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Pedro José Labronici
- Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Igor Vieira
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil
| | - Felipe Serrão de Souza
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° andar, GáveaRio de Janeiro, RJ, 22430-160, Brazil
| | - Tannous Jorge Sassine
- Departamento de Ortopedia, Escola de Medicina, Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | - Adriano Fernando Mendes
- Hospital Universitário, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
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15
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Park I, Shin SJ. Arthroscopic double-row bridge fixation provided satisfactory shoulder functional restoration with high union rate for acute anterior glenoid fracture. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07389-w. [PMID: 36995378 DOI: 10.1007/s00167-023-07389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To introduce a novel surgical technique for arthroscopic reduction and double-row bridge fixation using trans-subscapularis tendon portal for anterior glenoid fracture and to evaluate the clinical and radiological outcomes. METHODS A total of 22 patients who underwent arthroscopic reduction and double-row bridge fixation for an acute anterior glenoid fracture were retrospectively evaluated. Arthroscopic surgery was performed using four portals including a trans-subscapularis tendon portal. All patients underwent 3D-CT preoperatively and one day and one year postoperatively to evaluate the fracture fragment size, reduction status, and presence of fracture union. To evaluate the degree of fragment displacement, articular step-off and medial fracture gap were measured using 3D-CT. Clinical outcomes were assessed based on the ASES and Constant scores. Postoperative glenohumeral joint arthritis was evaluated using plain radiographs with the Samilson and Prieto classification. RESULTS The average preoperative fracture fragment size was 25.9 ± 5.6%. Articular step-off (preoperative: 6.0 ± 3.3 mm, postoperative one day: 1.1 ± 1.6 mm, P < 0.001) and medial fracture gap (preoperative: 5.2 ± 2.6 mm, postoperative one day: 1.9 ± 2.3 mm, P < 0.001) were improved after surgery. On the postoperative one year 3D-CT, 20 patients achieved complete fracture union, and two patients showed partial union. Postoperative glenohumeral joint arthritis was observed in four patients. At the last visit, the ASES score was 91.8 ± 7.0 and the Constant score was 91.6 ± 7.0. CONCLUSION Arthroscopic reduction and double-row bridge fixation using a trans-subscapularis tendon portal for acute anterior glenoid fracture achieved satisfactory clinical outcomes and anatomical reduction as demonstrated by a low degree of articular step-off and medial fracture gap. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-Gu, Seoul, 07804, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-Gu, Seoul, 07804, Republic of Korea.
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16
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Dobelle E, Robert S, Gaujac N, Laumonerie P, Mansat P, Bonnevialle N. Scapular fractures osteosynthesis via Judet's posterior approach: clinical and radiographic results. INTERNATIONAL ORTHOPAEDICS 2023; 47:1557-1564. [PMID: 36920480 DOI: 10.1007/s00264-023-05754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Scapular fractures are uncommon and mainly treated nonoperatively. Judet's posterior approach allows access to the fracture site through the infraspinatus fossa and may be a technical option when ORIF is decided. The aims of this study were to determine clinical and radiographic outcomes of patients who underwent scapular body and/or glenoid fractures fixation via Judet's posterior approach. METHODS We conducted a retrospective single-centre study, and all patients admitted for scapular fracture who underwent osteosynthesis via Judet's approach between January 2014 and September 2021 were included. At a minimum follow-up of one year, clinical outcomes were analyzed through subjective shoulder value (SSV) and Constant-Murley score (CMS). Strength in external rotation was measured in adduction and in 90° abduction and compared to healthy side. Radiographic analysis evaluated postoperative fracture reduction on CT scan and glenohumeral osteoarthritis according to Samilson's classification at last follow-up. RESULTS Twenty-one patients were included with a mean follow-up of 44.9 months. Mean SSV, CMS, and adjusted CMS were 73.8% ± 21.0, 65.8 points ± 19.5, and 72.8% ± 20.8, respectively. Strength in external rotation in adduction of the affected shoulder showed significant impairment when compared with the contralateral side (respectively 7.79 kg ± 4.29 and 12.0 kg ± 3.84, p = 0.02). All fractures healed uneventfully, but five patients (23.8%) required early revision surgery for intra-articular screws in three. Intra-articular gap measure decreased from 3.75 mm ± 1.93 in preoperative to 0.59 mm ± 0.97 after ORIF. The rate of arthritis was 15% at last follow-up. CONCLUSION Patients who underwent scapular fracture osteosynthesis via Judet's posterior approach exhibited satisfactory but incomplete recovery of the affected shoulder as evidenced by functional scores and external rotation strength measurements at a mean follow-up of 44.9 months. Because of the risk of intra-articular screws, postoperative CT scan is mandatory.
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Affiliation(s)
- Emile Dobelle
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France. .,Clinique Universitaire du Sport, Toulouse, France.
| | - Suzanne Robert
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France
| | - Nicolas Gaujac
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France
| | - Pierre Laumonerie
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France
| | - Pierre Mansat
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France.,Institut de Recherche Riquet (I2R), Toulouse, France
| | - Nicolas Bonnevialle
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France.,Institut de Recherche Riquet (I2R), Toulouse, France
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17
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Sivagurunathan G, Shirodkar K, Hegde G, Shamshuddin S, Proctor R, Naqvi J, Knowles D, Ali I. Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma. J Comput Assist Tomogr 2023; 47:264-276. [PMID: 36877776 DOI: 10.1097/rct.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
ABSTRACT There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.
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18
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Wafaisade A, Karwatzke A, Kappel P. Arthroskopische Frakturversorgung am Glenoid. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-023-00599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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19
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Mapping of Orthopaedic Fractures for Optimal Surgical Guidance. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1392:43-59. [PMID: 36460845 DOI: 10.1007/978-3-031-13021-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Orthopaedic fractures may be difficult to treat surgically if accurate information on the fracture propagation and its exit points are not known. Even with two-dimensional (2D) radiographic images, it is difficult to be completely certain of the exact location of the fracture site, the fracture propagation pattern and the exit points of the fracture. Three-dimensional (3D) computerised tomographic models are better in providing surgeons with the extent of bone fractures, but they may still not be sufficient to allow surgeons to plan open reduction and internal fixation (ORIF) surgery.Fracture patterns and fracture maps are developed to be visual tools in 2D and 3D. These tools can be developed using fractured bones either before or after fracture reduction. Aside from being beneficial to surgeons during pre-surgical planning, these maps aid bioengineers who design fracture fixation plates and implants for these fractures, as well as represent fracture classifications.Fracture maps can be either created ex silico or in silico. Ex silico models are created using 3D printed bone models, onto which fracture patterns are marked. In silico fracture models are created by tracing the fracture lines from a fractured bone to a healthy bone template on a computer. The points of interest in both of these representations are the path of fracture propagation on the bone's surface and exit zones, which eventually determine the surgeon's choice of plate and fracture reduction. Both ex silico and in silico fracture maps are used for pre-surgical planning by the surgeons where they can plan the best way to reduce the fracture as well as template various implants in a low-risk environment before performing the surgery.Recently, fracture maps have been further digitised into heat maps. These heat maps provide visual representations of critical regions of fractures propagating through the bone and identify the weaker zones in the bone structure. These heat maps can allow engineers to develop optimal surgical plates to fix an array of fracture patterns propagating through the bone. Correlation of fractured regions with the mechanisms of injury, age, gender, etc. may improve fracture predictability in the future and optimise the intervention, along with making sure that surgeons do not miss fractures of the bone that may otherwise be hidden from plain sight.
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20
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Morgan B, Prakash K, Mayberry JC, Brickley MB. Thoracic trauma: Clinical and paleopathological perspectives. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:50-63. [PMID: 36219928 DOI: 10.1016/j.ijpp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Although trauma is one of the most significant areas of study in paleopathology, most studies focus on fractures of single anatomical elements. Paleopathological research on regional trauma, such as of the thorax, is rare. This paper explores the causes, complications, and consequences of adult thoracic trauma using clinical data in order to inform paleopathological research. MATERIALS AND METHODS Trends in paleopathological thoracic trauma literature were assessed by evaluating publications from Bioarchaeology International, International Journal of Osteoarchaeology, International Journal of Paleopathology, and American Journal of Biological Anthropology. Clinical publications on thoracic trauma throughout time were also assessed through a PubMed search, and modern prevalence data was found through trauma databases such as the National Trauma Databank. RESULTS Consideration of thoracic trauma involving concomitant injuries is a recent trend in clinical literature and patient care, but paleopathological research on thoracic trauma has been limited. Since thoracic fractures tend to occur in conjunction with other injuries, assessing them together is critical to the interpretation of trauma in the past. CONCLUSIONS Clinical research into thoracic fractures and concomitant injuries provides valuable data for paleopathological research. Evaluating the likelihood and consequences of concomitant injury in skeletal remains provides a more robust understanding of trauma in the past and its impact on past lifeways. SIGNIFICANCE This paper provides a review of current clinical and paleopathological literature on thoracic trauma and demonstrates the importance of moving beyond the analysis of fractures or trauma of single anatomical elements. LIMITATIONS Thoracic bones are often taphonomically altered and differentially preserved leading to difficulty in identifying and interpreting fractures. SUGGESTIONS FOR FURTHER RESEARCH Practical application of the data presented here to archaeological samples will help to advance paleopathological understandings of thoracic trauma.
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Affiliation(s)
- Brianne Morgan
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
| | - Karanvir Prakash
- Virginia Commonwealth University, Department of Orthopedic Surgery, Richmond, VA, USA.
| | - John C Mayberry
- University of Washington, Department of Surgery, Seattle, WA 98195, USA.
| | - Megan B Brickley
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
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21
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Hoepelman RJ, Beeres FJP, van Veelen N, Houwert RM, Babst R, Link BC, van de Wall BJM. Treatment and outcome in combined scapula and rib fractures: a retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03437-2. [PMID: 36401000 DOI: 10.1007/s00590-022-03437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment strategies. METHODS All adult (≥ 18 years) patients with concurrent ipsilateral scapula and rib fractures admitted to the study hospital between 1st January 2010 and 31st June 2021 were retrospectively reviewed. RESULTS A total of 223 patients were admitted with concurrent ipsilateral rib and scapula fractures. A total of 160 patients (72%) were treated conservatively, 63 patients (28%) operatively. Among operatively treated patients, 32 (51%) underwent rib fixation (RF) only, 24 (38%) underwent scapula fixation (SF) only, and seven patients (11%) underwent combined fixation of scapula and ribs (SRF). In general, more severely injured patients were treated with more extensive surgery. RF patients had a median hospital length of stay of 16 days, the SF patients 11 days and SRF patients 18 days. There were no significant differences in complications (pneumonia, recurrent pneumothorax and revision surgery) between groups. CONCLUSION Injury severity resulted in different treatment modalities. As a result, different patient characteristics between treatment groups were observed, which makes direct comparison between treatment modalities impossible. All treatment modalities seem feasible; however, the additional value of both rib and scapula fixation has yet to be proven in large multicentre studies.
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Affiliation(s)
- Ruben Joost Hoepelman
- Department of Trauma Surgery, UMC Utrecht, Utrecht, the Netherlands
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Frank Joseph Paulus Beeres
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Nicole van Veelen
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Reto Babst
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bryan Joost Marinus van de Wall
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Spitalstrasse 16, 6000, Lucerne, Switzerland.
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22
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Ponkilainen V, Kuitunen I, Liukkonen R, Vaajala M, Reito A, Uimonen M. The incidence of musculoskeletal injuries: a systematic review and meta-analysis. Bone Joint Res 2022; 11:814-825. [DOI: 10.1302/2046-3758.1111.bjr-2022-0181.r1] [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] [Indexed: 11/16/2022] Open
Abstract
Aims The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates. Methods PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model. Results The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures. Conclusion The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries. Cite this article: Bone Joint Res 2022;11(11):814–825.
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Affiliation(s)
- Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland
| | - Rasmus Liukkonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Matias Vaajala
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Aleksi Reito
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
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23
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Nasir MU, Alsugair F, Sheikh A, Ouellette H, Munk P, Mallinson P. A Comprehensive Radiologic Review of Shoulder Girdle Trauma. Semin Musculoskelet Radiol 2022; 26:527-534. [PMID: 36535588 DOI: 10.1055/s-0042-1755431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiologic knowledge of different fracture patterns involving the shoulder girdle is an important tool to generate clinically relevant reports, identify concomitant injuries, guide management decisions, and predict and minimize complications, such as nonunion, osteoarthritis, osteonecrosis, and hardware failure. Complex unstable injuries like scapulothoracic dissociation can also occur because of shoulder girdle trauma. Management options may vary from conservative to surgical, depending on the fracture type and patient factors. Injuries around the shoulder girdle can involve the glenohumeral articulation, scapula, superior shoulder suspensory complex, acromioclavicular joints, and scapulothoracic articulation.
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Affiliation(s)
- Muhammad Umer Nasir
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Faisal Alsugair
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Adnan Sheikh
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Hugue Ouellette
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter Munk
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul Mallinson
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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24
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Pfister G, Murison JC, Sabate-Ferris A, Danis J, De l'Escalopier N, Mathieu L. Open Screw Fixation of Large Anterior Glenoid Rim Fractures Using a Deltopectoral Approach With Subscapularis Splitting. Tech Hand Up Extrem Surg 2022; 26:188-192. [PMID: 35288523 DOI: 10.1097/bth.0000000000000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anterior glenoid rim fracture is a consequence of the humeral head impacting the glenoid fossa. The management of large glenoid fractures involving more than 20% of the articulating glenoid requires surgical treatment. The 2 main techniques are open reduction internal fixation (ORIF) by screws and arthroscopic treatment using suture anchors or transcutaneous screws. Next to the technical equipment, a surgeon requires extensive experience to achieve good results with the arthroscopic technique. The main disadvantage using the ORIF technique is the detachment of the subscapularis muscle, which is often criticized for causing functional deficits of the subscapularis. Our study demonstrates the feasibility of the ORIF technique through a deltopectoral approach and splitting of the subscapularis. To our knowledge, subscapularis splitting has never been described to treat glenoid fractures.
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Affiliation(s)
- Georges Pfister
- Service de chirurgie orthopédique et traumatologie, Hôpital d'Instruction des Armées Percy, Henri Barbusse, Clamart, France
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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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Wang Y, Li Q, Zhang Q. Modified Double-Row and Double-Pulley Technique for the Treatment of Type Ia Scapular Glenoid Fractures. Orthop Surg 2022; 14:1518-1526. [PMID: 35638594 PMCID: PMC9251277 DOI: 10.1111/os.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the efficacy of the double‐row and double‐pulley technique in treating anterior shoulder glenoid fracture (Ideberg type Ia) using shoulder arthroscopy. Methods Thirty‐six patients with Ideberg type Ia admitted from March 1, 2017, to March 1, 2020, were retrospectively reviewed. Data of the patients' history included age, sex, side of the affected arm, the mean time from injury to surgery, the surgical duration, the average blood loss, and the average total duration of hospital stay. The double‐row and double‐pulley technique was used to repair the scapular glenoid fracture under arthroscopy. Computed tomography (CT) was used to evaluate fracture healing after surgery. The American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder joint scoring system, and the Constant–Murley shoulder function score were used to assess the function of the affected shoulder. Results The surgical duration was 90–150 min, with a mean of 127 min. The average blood loss was 90 mL (range, 60–120 mL), and the average total duration of hospital stay was 9.2 days (range, 3 to 14 days). At 9 months after surgery, the CT results showed that all fractures healed, and all patients returned to their previous levels of activity and regained an excellent range of motion. The visual analog scale (VAS) score was 7.55 ± 1.32 before surgery, and the VAS score significantly decreased to 1.24 ± 0.72 at 12 months after the operation (p < 0.05). The Constant, ASES, and UCLA shoulder function scores were 44.38 ± 2.16, 43.47 ± 12.76, and 21.80 ± 1.16 before the surgery, respectively, which improved to 93.52 ± 2.82, 91.34 ± 8.28, and 33.24 ± 1.64, respectively, in the following 12 months. One patient experienced fat liquefaction. However, no cases of deep venous thrombosis, iatrogenic neurovascular compromise, wound infection, or neurovascular injury were identified. Conclusion The double‐row and double‐pulley technique for treating Ideberg type Ia under shoulder arthroscopy has minor surgical trauma, reliable fracture reduction and fixation, less postoperative pain, and fewer postoperative complications and significantly improves the patient's shoulder joint function.
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Affiliation(s)
- Yizhong Wang
- Department of Sports medicine, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qingxian Li
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qingsong Zhang
- Department of Sports Medicine, Wuhan Forth Hospital, Wuhan, 430033, China
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Ubl ST, Kappel P, Imach S, Bouillon B, Wafaisade A. Arthroskopische Schraubenfixation einer transversen Glenoidfraktur. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ZusammenfassungTransverse Glenoidfrakturen sind selten und treten meist mit Begleitverletzungen auf. Vorgestellt wird der Fall eines 50-jährigen Mannes, der eine Glenoidfraktur (Typ III nach Ideberg) als Teilverletzung des „superior shoulder suspensory complex“ erlitt. Die Schraubenfixation erfolgte arthroskopisch durch ein hohes, anteromediales Portal. Auf die übliche Anlage des Neviaser-Portals wurde verzichtet. Nach 3 Monaten konnte ein sehr gutes klinisches Ergebnis und eine Durchbauung der Glenoidfraktur beobachtet werden. Die arthroskopische Versorgung von Typ-III-Glenoidfrakturen stellt eine Alternative zu offenen Verfahren dar.
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Huflage H, Fieber T, Färber C, Knarr J, Veldhoen S, Jordan MC, Gilbert F, Bley TA, Meffert RH, Grunz JP, Schmalzl J. Interobserver reliability of scapula fracture classifications in intra- and extra-articular injury patterns. BMC Musculoskelet Disord 2022; 23:189. [PMID: 35232415 PMCID: PMC8886840 DOI: 10.1186/s12891-022-05146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Morphology and glenoid involvement determine the necessity of surgical management in scapula fractures. While being present in only a small share of patients with shoulder trauma, numerous classification systems have been in use over the years for categorization of scapula fractures. The purpose of this study was to evaluate the established AO/OTA classification in comparison to the classification system of Euler and Rüedi (ER) with regard to interobserver reliability and confidence in clinical practice. Methods Based on CT imaging, 149 patients with scapula fractures were retrospectively categorized by two trauma surgeons and two radiologists using the classification systems of ER and AO/OTA. To measure the interrater reliability, Fleiss kappa (κ) was calculated independently for both fracture classifications. Rater confidence was stated subjectively on a five-point scale and compared with Wilcoxon signed rank tests. Additionally, we computed the intraclass correlation coefficient (ICC) based on absolute agreement in a two-way random effects model to assess the diagnostic confidence agreement between observers. Results In scapula fractures involving the glenoid fossa, interrater reliability was substantial (κ = 0.722; 95% confidence interval [CI] 0.676–0.769) for the AO/OTA classification in contrast to moderate agreement (κ = 0.579; 95% CI 0.525–0.634) for the ER classification system. Diagnostic confidence for intra-articular fracture patterns was superior using the AO/OTA classification compared to ER (p < 0.001) with higher confidence agreement (ICC: 0.882 versus 0.831). For extra-articular fractures, ER (κ = 0.817; 95% CI 0.771–0.863) provided better interrater reliability compared to AO/OTA (κ = 0.734; 95% CI 0.692–0.776) with higher diagnostic confidence (p < 0.001) and superior agreement between confidence ratings (ICC: 0.881 versus 0.912). Conclusions The AO/OTA classification is most suitable to categorize intra-articular scapula fractures with glenoid involvement, whereas the classification system of Euler and Rüedi appears to be superior in extra-articular injury patterns with fractures involving only the scapula body, spine, acromion and coracoid process.
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Affiliation(s)
- Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Tabea Fieber
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Christian Färber
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Jonas Knarr
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Martin C Jordan
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rainer H Meffert
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Jonas Schmalzl
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
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Identification of recurring scapular fracture patterns using 3-dimensional computerized fracture mapping. J Shoulder Elbow Surg 2022; 31:571-579. [PMID: 34628033 DOI: 10.1016/j.jse.2021.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapular fracture fixation and implant selection are guided by the fracture pattern and classification, which requires accurate understanding and interpretation of the fracture lines. Three-dimensional (3D) computed tomography (CT)-based fracture pattern analysis enhances a more accurate understanding of the scapular fracture patterns. The purpose of this study was to create scapular fracture maps and identify the frequent fracture patterns using 3D reconstructed CT images. METHOD Seventy patients treated for scapular fractures, in a single hospital, were considered for this study. Their CT images were reconstructed into 3D models and the fracture fragments were virtually reduced. The reduced 3D models were first aligned on a 3D template and 2D images were captured on the anterior, posterior, and lateral views. Then each fracture image was aligned on a corresponding 2D template and the fracture lines were transferred to the template. The 3 separate views were used to accurately capture the propagation and exit of the fractures through the scapular anatomy. These fracture lines were compiled and heat maps were generated to identify the frequent fracture zones of the scapula. RESULT The observed scapular fractures propagated through multiple regions of the bone. Overall, the 3 most common exit zones in the scapula were the lateral (69%), medial (67%), and superior borders (60%). More specifically, the superior lateral border, medial base of the scapula spine, spinoglenoid notch, and mid-superior border were the most frequent zones of fracture in the scapular body. Simple intra-articular fractures (transverse or oblique type) were the most common (92%) fracture type in the glenoid region. CONCLUSION Scapular fractures reveal repeatable patterns. The zones of recurrent fracture patterns can be identified from fracture and heat maps. Graphical plots of fracture and heat maps may assist surgical planning and implant design optimization.
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Lin IH, Lin TL, Chang HW, Lin CY, Tsai CH, Lo CS, Chen HY, Chen YW, Hsu CJ. Arthroscopy-Assisted Reduction and Internal Fixation versus Open Reduction and Internal Fixation for Glenoid Fracture with Scapular Involvement: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11041131. [PMID: 35207402 PMCID: PMC8875088 DOI: 10.3390/jcm11041131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open
Abstract
Background: We investigated the superiority of arthroscopy-assisted reduction and internal fixation (ARIF) to open reduction and internal fixation (ORIF) for treating glenoid fracture with scapular involvement. Methods: We retrospectively enrolled patients with glenoid fracture who underwent ARIF or ORIF from 2010–2020. Radiographic outcomes were assessed, and clinical outcomes (active range of motion [ROM], visual analog scale [VAS], Constant, and Disabilities of the Arm, Shoulder and Hand [DASH]) were evaluated 12 months postoperatively. Results: Forty-four patients with Ideberg type II–VI glenoid fractures (ARIF: 20; ORIF: 24; follow-up 12–22 months) were included. Union was achieved in all patients. Active ROM values were comparable between the approaches. Constant and DASH scores were non-significantly better with ARIF (90.9 ± 9.2 vs. 86.6 ± 18.1 [p = 0.341] and 6.8 ± 9.4 vs. 9.3 ± 21.3 [p = 0.626], respectively). However, VAS scores were significantly lower with ARIF (1.5 ± 0.6 vs. 2.7 ± 1.4, p = 0.001). Associated intra-articular lesions (articular depressions [80%], superior labral anterior-posterior tear [20%], labral tears [30%]) were found in most ARIF cases and were repaired during ARIF. Conclusions: For glenoid fracture with scapular involvement, ARIF allows accurate diagnosis of fracture pattern and the management of associated intra-articular lesions, with better pain control outcomes than ORIF. Thus, arthroscopy-assistant surgery should be considered in patient with glenoid fracture.
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Affiliation(s)
- I-Hao Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan;
| | - Hao-Wei Chang
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
| | - Chia-Yu Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
| | - Chien-Sheng Lo
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Hui-Yi Chen
- Department of Medical Image, China Medical University Hospital, Taichung 40447, Taiwan;
| | - Yi-Wen Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan;
- X-Dimension Center for Medical Research and Translation, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
| | - Chin-Jung Hsu
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan; (I.-H.L.); (T.-L.L.); (H.-W.C.); (C.-Y.L.); (C.-H.T.)
- School of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Correspondence: ; Tel.: +886-4-2205-2121
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TERRA BERNARDOBARCELLOS, SASSINE TANNOUSJORGE, PINHEIRO JOÃOVICTORREZENDESOARES, LOPES MATHEUSALBERTONUNES, SOUSA DHYEGOBONELLEDE, AMORIM VINICIUSSOUZA. RESULTS OF THE SURGICAL TREATMENT OF ARTICULAR SCAPULAR FRACTURES. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e247095. [PMID: 36092175 PMCID: PMC9425968 DOI: 10.1590/1413-785220223004e247095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
Introduction: Scapular fractures are rare injuries and are often associated with high-energy trauma, with joint fractures accounting for only 15% of all scapular fractures. Surgical treatment is indicated for fractures with large deviations and with joint instability. Objective: This study evaluates the clinical and functional results after surgical treatment of scapular fractures. Methods: Eight patients with scapular fractures were surgically treated between 2013 and 2019. For indication for surgical treatment, mediolateral deviations, glenopolar angle, angular deviations and joint deviations greater than 4 mm were taken into account. Radiographic results of consolidation, range of motion, functional score and visual analogue pain scale were obtained. Results: In the mean follow-up of twenty-nine months (13-40 months), all patients presented fracture consolidation. The mean UCLA score was 29 points (with 75% good results and 25% moderate results). Regarding the range of motion, the mean elevation was 146° (ranging from 110° to 60°), lateral rotation of 62° (36-80°) and medial rotation at the level of T7 (T6-T10). The final VAS mean was 2.3. All patients returned to the pre-injury level at work. Conclusion: In this series of cases, surgical treatment of scapular articular fractures provided satisfactory results with low rates of complications, showing to be an option in selected cases of deviated fractures. Level of Evidence IV, Case Series.
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Königshausen M, Pätzholz S, Coulibaly M, Nicolas V, Vandemeulebroecke M, Schildhauer TA, Seybold D. Instability and results after non-operative treatment of large anterior glenoid rim fractures: is there a correlation between fragment size or displacement and recurrence? Arch Orthop Trauma Surg 2022; 142:2727-2738. [PMID: 34338888 PMCID: PMC9474463 DOI: 10.1007/s00402-021-04020-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/23/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION There is little data available on non-operative treatment of anterior glenoid rim fractures (GRF). Nothing is known about fracture size and displacement in comparison to clinical outcomes and instability in a mainly middle-aged patient population. The aim of this study was to demonstrate the results of non-operative treatment in anterior glenoid rim fractures with the special focus on potential instability/recurrence. METHODS The inclusion criteria were non-operatively treated anterior GRF of at least ≥ 5 mm width using the age- and gender-matched Constant/Murley score (a.-/g.-CMS) and the Western Ontario Instability Index (WOSI). Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill-Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. and axial radiographs) was classified according to Samilson/Prieto. Proportion of fractured glenoid and medial displacement were correlated with the recurrence rate and the clinical scores. RESULTS N = 36 patients could be followed-up after a mean of 4.4 years [12-140 month, average age: 58 (± 13, 33-86) years]. The a.-/g.-CMS was 93 (± 11, 61-100) points, and the WOSI was 81% (± 22%, 35-100%) on average. The mean intraarticular displacement was 4 mm (± 3 mm; 0-14 mm). The 2D-circle-method showed a mean glenoid fracture involvement of 21% (± 11, 10-52%). Two cases of frozen shoulders and one case with biceps pathology were associated with the trauma. Within the followed-up patient group re-instability has occurred in n = 2 patients (6%) within the first two weeks after trauma. Osteoarthritis was found in n = 11 cases. There was no correlation between the scores and the fracture size/displacement [(a.-/g.-CMS vs. displacement: r = - 0.08; p = 0.6; vs. size: r = - 0.29; p = 0.2); (WOSI vs. displacement: r = - 0.14; p = 0.4; vs. size: r = - 0.37; p = 0.06)], but very large (≥ 21%) fractures with displacement ≥ 4 mm showed slightly worse results without significant difference (a.-/g.-CMS p = 0.2; WOSI p = 0.2). The apprehension test was negative in all patients at final follow-up. CONCLUSION Non-operative treatment of anterior GRF was associated with overall good results within a mainly middle-aged larger patient group. Re-instability is rare and is not associated with fragment size but can occur in the first weeks after trauma. Size and dislocation of the fracture is not a criterion for the prognosis of potential instability. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Matthias Königshausen
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Simon Pätzholz
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marlon Coulibaly
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Volkmar Nicolas
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marc Vandemeulebroecke
- Biostatistical Sciences and Pharmacometrics, Novartis Pharma AG, Klybeckstrasse, 4057, Basel, Switzerland
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Mohanty K, Agarwal R. Trauma. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1007/978-3-030-78529-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bao MH, DeAngelis JP, Wu JS. Imaging of traumatic shoulder injuries – Understanding the surgeon’s perspective. Eur J Radiol Open 2022; 9:100411. [PMID: 35265737 PMCID: PMC8899241 DOI: 10.1016/j.ejro.2022.100411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 12/18/2022] Open
Abstract
Imaging plays a key role in the assessment and management of traumatic shoulder injuries, and it is important to understand how the imaging details help guide orthopedic surgeons in determining the role for surgical treatment. Imaging is also crucial in preoperative planning, the longitudinal assessment after surgery and the identification of complications after treatment. This review discusses the mechanisms of injury, key imaging findings, therapeutic options and associated complications for the most common shoulder injuries, tailored to the orthopedic surgeon’s perspective.
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Martika W, Dilogo IH, Setyawan R. Functional outcome in scapular fracture treatment evaluation with 2-year follow-up in Cipto Mangunkusumo Hospital. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wafaisade A, Kappel P, Pfeiffer TR, Lambert C, Banerjee M. Arthroscopic Screw Fixation Technique for Transverse Glenoid Fractures. Arthrosc Tech 2021; 10:e2495-e2499. [PMID: 34868853 PMCID: PMC8626685 DOI: 10.1016/j.eats.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/18/2021] [Indexed: 02/03/2023] Open
Abstract
Transverse glenoid fractures with a cranial coracoglenoidal fragment (Ideberg type III) can lead to detrimental post-traumatic sequelae. Open surgery requires an extensive surgical approach. Arthroscopic procedures are highly challenging with respect to both fracture reduction and screw osteosynthesis. We present a reproducible arthroscopic technique for a dislocated transverse glenoid fracture using 5 standard portals. Grasping the coracoid with a small, serrated reduction clamp through the anterior portal allows simple and sufficient reduction. Safe screw osteosynthesis can then be performed from cranially without the need to create a Neviaser portal.
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Affiliation(s)
- Arasch Wafaisade
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center
- Address correspondence to Arasch Wafaisade, M.D., Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Ostmerheimer Str. 200, D-51109 Cologne, Germany.
| | - Paola Kappel
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center
| | - Thomas R. Pfeiffer
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center
| | - Christophe Lambert
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center
| | - Marc Banerjee
- Department of Orthopedic Surgery and Sports Traumatology, Atos MediaPark Clinic, Cologne, Germany
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Ogawa K, Matsumura N, Yoshida A, Inokuchi W. Fractures of the coracoid process: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:171-178. [PMID: 37588963 PMCID: PMC10426686 DOI: 10.1016/j.xrrt.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Although fracture of the coracoid process (CF) used to be considered rare, it is now more commonly encountered due to increased awareness and advances in imaging methods. This review aimed to analyze reported cases of CF to determine its mechanism and appropriate treatment. Methods PubMed and Scopus were searched using the terms "scapula fracture" and "coracoid fracture." The inclusion criteria were English full-text articles concerning CF that described patient characteristics with appropriate images. The exclusion criteria included cases without appropriate images and those with physeal injury or nonunion. Citation tracking was conducted to find additional articles and notable full-text articles in other languages. Fractures were mainly classified using Ogawa's classification. Results Ninety-seven studies were identified, including 197 patients (131 men, 33 women; average age 37.0±16.9 years). CF was classified as type I in 77%, type II in 19%, and avulsion fracture at the angle in 5%. Concurrent shoulder girdle injuries included acromioclavicular injury in 33%, clavicular fracture in 17%, acromion or lateral scapular spine fracture in 15%, and anterior shoulder instability in 11%. Among patients with type I CF, 69% had multiple disruptions of the superior shoulder suspensory complex. Conservative treatment was applied in 71% of isolated type I CF, while surgical treatment was applied in 76% of type I CF with multiple disruptions. Although the evaluation methods varied, 60% of patients were followed up for more than 6 months, and the outcomes were generally satisfactory for both conservative and surgical treatments. Conclusion CF occurred commonly in the age group with higher social activity. The most common fracture type was type I. The possible mechanism of CF is violent traction of the attached muscles, except for avulsion fracture at the angle. Type I CF with multiple disruptions of the superior shoulder suspensory complex requires surgical treatment, whereas conservative care is recommended for isolated type I and type II CFs.
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Affiliation(s)
- Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, Taito-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, Wako City, Saitama, Japan
| | - Wataru Inokuchi
- Department of Orthopedic Surgery, Eiju General Hospital, Taito-ku, Tokyo, Japan
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Abstract
A consensus is beginning to emerge about the indications for fixation of fractures involving the glenoid fossa of the scapula. The same cannot be firmly said for extra-articular fractures of the blade or the processes of the scapula, with a good deal of reliance on expert opinion from high-volume centres. There are no randomized controlled studies and the systematic reviews that do exist can only pool the data from available case series, making meaningful meta-analysis of limited value. Interest in scapula fractures has increased of late due to the specific association of fractures of the scapular spine and acromion with reverse shoulder arthroplasty. This review summarizes the available evidence that can assist decision making when faced with a patient with a scapula fracture. Which patients should at least be considered for open reduction and internal fixation, either in the centre where they present or after referral to a more specialist centre? These patients are those with a fracture sufficiently displaced that it interferes with the mechanical function of the shoulder girdle and the aim of fixation is to reduce pain and disability. Since the majority of scapula fractures heal quickly with non-surgical treatment and do not cause significant disability, decision making can be difficult, and it is perhaps the case that it is easier to err on the side of caution. However, it seems that there are fracture types, such as significantly displaced double disruptions of the superior suspensory complex, widely displaced lateral column fractures and fractures producing angular deformity of the glenoid process, that benefit from early reduction and stabilization with the expectation of a good outcome for the patient.
Cite this article: EFORT Open Rev 2021;6:518-525. DOI: 10.1302/2058-5241.6.210010
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Affiliation(s)
- David Limb
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Attarde D, Patil A, Kamat N, Sancheti P, Shyam A. Anterior proximal humerus fracture dislocation with concomitant glenoid fracture: An operative challenge! A case report. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211019528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Combined proximal humerus fracture dislocation and glenoid fracture is a rare combination of injuries which presents technical operative challenges. There is little evidence to guide surgical management. Case Report We report a case of a proximal humerus fracture with anterior dislocation and glenoid fracture treated in the same sitting with open reduction and internal fixation with angular stability locking plate and cannulated screw. The surgical technique involved standard deltopectoral approach with coracoid osteotomy. Conclusion By addressing both fractures operatively at the same time, we reported a satisfactory clinical and functional outcome with bony union of the fracture sites without instability at end of 1 year. Coracoid osteotomy may open an alternative pathway to treat complex proximal humerus injuries with ipsilateral glenoid fracture.
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Affiliation(s)
- Dheeraj Attarde
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Atul Patil
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Nilesh Kamat
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Parag Sancheti
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Ashok Shyam
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
- Indian Orthopaedic research group, Thane, India
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Rollo G, Huri G, Meccariello L, Familiari F, Çetik RM, Cataldi C, Conteduca J, Giaracuni M, Bisaccia M, Longo D, Giannotti PS. Scapular body fractures: Short-term results of surgical management with extended indications. Injury 2021; 52:481-486. [PMID: 32951918 DOI: 10.1016/j.injury.2020.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/12/2020] [Accepted: 09/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Scapular body fractures represent less than 1% of all skeletal fractures. Operative criteria and risk factors for scapular fracture instability are well defined. Non-operative management of scapular body fractures show satisfactory results but with shortening and medialization of the scapular body. The aim of this study is to evaluate if surgical treatment will result in an improved quality of life and shoulder function compared to non-operative treatment on patients suffering from a scapular body fracture. MATERIALS AND METHODS From a total of 381 retrospectively identified scapular body fractures, we included 45 patients. The enrolled patients were divided into two groups: the surgical treatment (ST, n = 20) group and the non-operative treatment (NOT, n = 25) group. The Non-Union Scoring System (NUSS) was used to assess bone healing on radiographs. The functional evaluation of the two groups during the follow-up were performed using the Constant Shoulder Score (CSS) and the Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH). Complications, reoperation rates, and time until bony union were also documented. The minimum follow-up for this study was designated as 12 months. RESULTS The ST group had better mean CSS and QuickDASH scores compared to the NOT group at 1, 3 and 6 months of follow-up. No statistically significant difference was detected at 12 months follow-up. ST group also demonstrated improved results in time until bone union, reduction of rehabilitation time, complications and return to work rates. CONCLUSION This study suggests that surgical treatment for extraarticular scapular fractures can achieve better short-term functional outcomes (3 to 6 months) compared to conservative treatment.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, 73100 Lecce, Italy
| | - Gazi Huri
- Department of Orthopaedics and Traumatology, Hacettepe University Hospital, Ankara, Turkey
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, 73100 Lecce, Italy.
| | - Filippo Familiari
- Department of Orthopedics and Traumatology, Villa del Sole Clinic, Catanzaro, Italy
| | - Rıza Mert Çetik
- Department of Orthopaedics and Traumatology, Hacettepe University Hospital, Ankara, Turkey
| | - Carlo Cataldi
- Department of Orthopedics and Traumatology, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Jacopo Conteduca
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, 73100 Lecce, Italy
| | - Marco Giaracuni
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, 73100 Lecce, Italy
| | - Michele Bisaccia
- Department of Surgical and Biomedical Science, Orthopaedics and Traumatology Unit, S.M. Misericordia Hospital, University of Perugia, Sant'Andrea delle Fratte, Perugia, Italy
| | - Damiano Longo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, 73100 Lecce, Italy
| | - Prof Stefano Giannotti
- Department of Orthopedics and Traumatology, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
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Tüzün HY, Erşen Ö, Arsenishvili A, Türkkan S, Kürklü M. Functional outcomes of internal fixation of scapula fractures due to high-velocity gunshot injuries. Eur J Trauma Emerg Surg 2021; 48:1987-1992. [PMID: 33599792 DOI: 10.1007/s00068-021-01614-2] [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: 08/23/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Open fractures of the scapula are relatively rare and only a few studies are interested in this subject. This study aims to demonstrate the results of internal fixation of open scapula fractures due to gunshot injuries. MATERIALS AND METHODS Eight patients who had open scapula fractures and were treated by internal fixation through the conventional Judet approach included in this study. Patients were followed up monthly in the first 6 months and every 2 months in the rest of the follow-up. Shoulder range of motion, Constant Shoulder Score, and Disabilities of the Arm, Shoulder, and Hand score were used for functional evaluation. RESULTS The average follow-up period was 34.6 ± 11.9 months. The average time between injuries and the surgery was 10.5 ± 5.1 days. The average shoulder abduction of the patients was 135.6 ± 18.8°, the average forward flexion of the shoulder was 160 ± 19.2°. The average internal and external rotations of the shoulders were 80 ± 14.1° and 63.1 ± 17.3°, respectively. CSS was calculated as 79.8 ± 14.4, and DASH was calculated as 14.1 ± 14.9. CONCLUSIONS In the treatment of open scapula fractures due to gunshot injuries, an internal fixation is a reliable option and the results were comparable with previous studies.
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Affiliation(s)
- Harun Yasin Tüzün
- Department of Orthopedics, Gülhane Education and Research Hospital, Etlik, Keçiören, Ankara, Turkey
| | - Ömer Erşen
- Department of Orthopedics, Gülhane Education and Research Hospital, Etlik, Keçiören, Ankara, Turkey.
| | - Arsen Arsenishvili
- Ministry of Defence Hospital, Department of Orthopedics and Traumatology, Gori, Georgia
| | - Selim Türkkan
- Department of Orthopedics, Memorial Service Hospital, Istanbul, Turkey
| | - Mustafa Kürklü
- Department of Orthopedics, Memorial Private Hospital, Istanbul, Turkey
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Pires RE, Giordano V, de Souza FSM, Labronici PJ. Current challenges and controversies in the management of scapular fractures: a review. Patient Saf Surg 2021; 15:6. [PMID: 33407725 PMCID: PMC7789406 DOI: 10.1186/s13037-020-00281-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
Fractures of the scapula are rare and usually associated with high-energy trauma. The unfavorable scapular anatomy, combined with the complexity of the approaches for fracture fixation, make the treatment challenging, even for experienced surgeons. Furthermore, the literature is controversial regarding surgical indications and rationale for treatment. The present review article was designed to address and discuss critical aspects of decision-making for the management of scapular fractures, including surgical indications and patient safety considerations.
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Affiliation(s)
- Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, Brazil. .,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, MG, Brazil.
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro, Rio de Janeiro, RJ, Brazil.,Clínica São Vicente, Rede D'Or São Luiz, Rio de Janeiro, RJ, Brazil
| | | | - Pedro José Labronici
- Serviço de Ortopedia e Traumatologia, Hospital Santa Teresa, Petrópolis, RJ, Brazil
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Malunions and Nonunions of the Acromion and Coracoid Proceses: A Comparison of Functional Outcomes Before and After Reconstruction. J Orthop Trauma 2020; 34:669-674. [PMID: 32427816 DOI: 10.1097/bot.0000000000001840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess surgical and functional outcomes in a cohort of patients having operatively reconstructed scapula process malunions and/or nonunions. DESIGN Retrospective case series. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Between 2003 and 2018, we identified 16 patients who presented to our institution with symptoms associated with a nonunion or malunion of closed, displaced fractures of the scapula processes after acute injury mechanisms. INTERVENTION Surgical osteotomy of the malunion or debridement of the nonunion and subsequent reconstruction. MAIN OUTCOME MEASUREMENTS The primary outcome measured included range of motion, strength, and DASH. Return to work was a secondary outcome. RESULTS Among 13 of the 16 (81%) patients with ≥12 months follow-up, the mean follow-up was 34 months (range, 12-112 months). Three patients were lost to follow-up. The mean DASH score improved from 56.4 ± 22.4 preoperatively to 23.4 ± 22.2 postoperatively (P < 0.001). Among the patients with ≥1-year follow-up, range of motion improved from preoperative to final follow-up in abduction (P = 0.020). Among the 15 of 16 patients for whom occupation data are available, 73% either returned to their original occupation (n = 7) or did not due to reasons other than their reconstructive surgery (n = 4). Two postoperative complications occurred including failure of acromion nonunion fixation at 4 months and went on to heal after revision surgery. All reconstructions united without malunion. CONCLUSIONS Reconstruction of the scapula process malunion and nonunion is possible, providing restoration of function and symptom relief, with a low complication rate. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Ernstbrunner L, Jessen M, Wieser K. Anatomic healing after non-operative treatment of a large, displaced anterior glenoid rim fracture after primary traumatic anterior shoulder dislocation – a case report. BMC Musculoskelet Disord 2020; 21:361. [PMID: 32517721 PMCID: PMC7285733 DOI: 10.1186/s12891-020-03384-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
Background Large, displaced anterior glenoid rim fractures after primary traumatic anterior shoulder dislocation are usually managed by surgical stabilization. Although there is little evidence supporting surgical management, it is often preferred over non-operative treatment. This case report describes non-operative management of such large, displaced anterior glenoid rim fracture with CT- and MRI-based documentation of anatomical healing of the fracture fragment, a finding that has not been described previously. Case presentation This case report describes a 49-year-old male, right-hand dominant, carpenter, who had a left-sided primary anterior shoulder dislocation after a fall while skiing. Initial plain radiographs showed a reduced glenohumeral joint with a large, displaced anterior glenoid rim fracture. CT-evaluation showed a centered humeral head, and as per our institutional protocol, non-operative management was initiated. Longitudinal radiographic assessment at 2 weeks, 4.5 months and 12 months showed reduction of the initially severely displaced fracture fragment. MRI- and CT-evaluation after 12 months confirmed anatomical healing of the fragment. At final follow-up, the patient was highly satisfied, although the healing process was complicated by posttraumatic frozen shoulder, which has had almost fully resolved after 12 months. Conclusions Given that the glenohumeral joint is concentrically reduced, large (displaced) anterior glenoid rim fractures after traumatic primary shoulder dislocation can be successfully treated non-operatively, with the potential of anatomical fracture fragment healing. Therefore, it remains subject to conservative treatment at our institution and surgical stabilization is reserved for patients with a decentered humeral head or persistent glenohumeral instability.
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Oh JC, Kim HS, Lee GH, Kang HJ. Arthroscopic treatment of a one-fourth anteroinferior glenoid comminuted fracture-dislocation with concomitant three-part complex proximal humerus fracture in a middle-aged man: a case report. Arch Orthop Trauma Surg 2020; 140:1901-1907. [PMID: 32140828 DOI: 10.1007/s00402-020-03402-w] [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: 12/05/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Proximal humeral fracture-dislocations can occur in high-energy traumas. This injury can be accompanied by a glenoid fracture; however, it is a rare type of complex injury in patients aged under 60 years. MATERIALS AND METHODS A 53-year-old man presented with a three-part fracture-dislocation of the proximal humerus and a severely comminuted glenoid fracture. For the glenohumeral dislocation and proximal humeral fracture, we performed closed reduction using a threaded Steinman pin and fixation with percutaneous cannulated screws. Using arthroscopy, while maintaining humeral traction with the Steinman pin, the intra-articular glenoid fragments were reduced and then fixed with a buttressing headless screw and one suture anchor. After a 6-week immobilization with a shoulder spica cast, rehabilitation was initiated. RESULTS We confirmed bony union of the fracture sites after 6 months post-surgery. The patient showed excellent clinical outcomes with a nearly full range of motion without instability CONCLUSIONS: We reported a successful outcome for a complex proximal humeral fracture involving the glenoid using closed reduction and fixation for the proximal humeral fracture and arthroscopic reduction and fixation for the comminuted anteroinferior glenoid fracture.
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Affiliation(s)
- Jin-Chul Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Hyoung-Sik Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Gi-Hoon Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
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Abstract
Glenoid fractures are unique in which they span the fields of orthopaedic traumatology and sports medicine. Treatment of glenoid fractures, whether surgical or nonsurgical, may be challenging and have long-term implications on pain and shoulder function. Plain radiographs are always indicated, and most glenoid fractures will require advanced imaging in the form of CT scan. Two general categories of glenoid fractures exist and differ in mechanism of injury, fracture morphology, and treatment. The first category is glenoid fractures with extension into the scapular neck and body. These fractures are typically from high-energy trauma and are often associated with other orthopaedic and nonorthopaedic injuries. The second category includes glenoid rim fractures, which are typically consequent of lower energy mechanisms and are associated with shoulder instability events. Treatment of glenoid rim fractures is dictated by the size and displacement of the fracture fragment and may be nonsurgical or surgical with either open and arthroscopic techniques. The purpose of this review was to discuss the current evidence on glenoid fractures regarding diagnosis, classification, management, and outcomes.
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47
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Abstract
Glenoid fractures of the shoulder are uncommon. Any scapular fracture involving the glenoid should be scrutinized carefully for a surgical treatment option. Classification is helpful in deciding the surgical tactic.
Cite this article: EFORT Open Rev 2020;5:620-623. DOI: 10.1302/2058-5241.5.190057
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Affiliation(s)
- Peter Ström
- Uppsala University Hospital - Department of Orthopaedics, Uppsala, Sweden
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48
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Toru M, Hideaki S, Tsunemasa M. Ideberg type III glenoid fractures are caused by indirect force: A report of four cases. Trauma Case Rep 2020; 30:100363. [PMID: 33088890 PMCID: PMC7566841 DOI: 10.1016/j.tcr.2020.100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 11/26/2022] Open
Abstract
Ideberg type III glenoid fractures are relatively rare, and the mechanisms of injury and treatment strategies remain controversial. We reviewed the fracture patterns and final radiological findings in four cases. All fractures were wider on the medial side than on the side of the articular surface. All patients had multiple ipsilateral rib fractures; three out of four patients had a concomitant acromion fracture. Therefore, the mechanism of injury for the fracture is assumed to be external force applied in the caudal direction to the medial side of the body of the scapula. The superior shoulder suspensory complex was disrupted in most cases. A good clinical outcome was obtained in two patients with percutaneous screw fixation for the glenoid fracture and rigid plate fixation for the acromion fracture and in one patient who did not have an acromion fracture. However, one patient who did not undergo fixation of the acromion fracture developed osteoarthrosis of the shoulder joint. In this type of fracture, it is important to stabilize the acromion fracture at the same time as fixation of the glenoid fracture.
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Affiliation(s)
- Matsugaki Toru
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka City, Japan
| | - Shibata Hideaki
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka City, Japan
| | - Matsubara Tsunemasa
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka City, Japan
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Wieser K, Waltenspül M, Ernstbrunner L, Ammann E, Nieuwland A, Eid K, Gerber C. Nonoperative Treatment of Anterior Glenoid Rim Fractures After First-Time Traumatic Anterior Shoulder Dislocation: A Study with 9-Year Follow-up. JB JS Open Access 2020; 5:e20.00133. [PMID: 33376928 PMCID: PMC7757836 DOI: 10.2106/jbjs.oa.20.00133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary traumatic anterior shoulder dislocations can be associated with displaced anterior glenoid rim fractures. Nonoperative treatment of such fractures has been shown to have excellent results in a small cohort of patients; as such, we have been treating these fractures nonoperatively, regardless of fragment size and degree of displacement, provided that post-reduction computed tomography scans revealed an anteroposteriorly centered humeral head. The aim of this study was to analyze the medium- to long-term results of nonoperative treatment of displaced anterior glenoid rim fractures, assessing in particular the residual instability and development of osteoarthritis. METHODS In a 2-center study, 30 patients with a mean age of 48 years (range, 29 to 67 years) were evaluated clinically with use of the Subjective Shoulder Value, Constant score, American Shoulder and Elbow Surgeons score, and Western Ontario Shoulder Instability index, as well as radiographically with use of radiographs and computed tomography scans at a mean follow-up of 9 years (range, 5 to 14 years). RESULTS Fracture-healing was documented in all patients. Seven patients (23%) had post-fracture onset of osteoarthritis (5 with Samilson grade I and 2 with Samilson grade IV). Of these, 1 patient had recurrent instability that was successfully treated with hemiarthroplasty 9 years after the index injury (relative Constant score, 101%), and was excluded from further analysis. No other patient had a recurrent redislocation, subluxation, or positive apprehension. The other 6 patients with new-onset radiographic osteoarthritis were pain-free (mean Constant score pain scale, 15 points) with good shoulder function (relative Constant score, 84% to 108%). A total of 26 patients (90%) rated their functional outcome as good or very good, and 3 patients (10%) rated it as fair. The mean relative Constant score was 97% (range, 61% to 108%), the mean American Shoulder and Elbow Surgeons score was 92 points (range, 56 to 100 points), and the mean Western Ontario Shoulder Instability index score was 126 points (range, 0 to 660 points). All patients returned to full-time work. CONCLUSIONS Nonoperative treatment of anterior glenoid rim fractures following primary traumatic anterior shoulder dislocation results in excellent clinical outcomes with a very low rate of residual instability and, thus, treatment failure. Asymptomatic radiographic osteoarthritis occurred in roughly 1 of 4 patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Manuel Waltenspül
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Elias Ammann
- Department of Orthopaedics, Kantonsspital Baden, Baden, Switzerland
| | - Arend Nieuwland
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Eid
- Department of Orthopaedics, Kantonsspital Baden, Baden, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Zheng J, Lu N, Shen Z, Chen A. Superior approach for treating Ideberg III glenoid fractures with superior shoulder suspensory complex injury: A technical trick. Trauma Case Rep 2020; 29:100343. [PMID: 32939390 PMCID: PMC7479435 DOI: 10.1016/j.tcr.2020.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/02/2022] Open
Abstract
Ideberg III glenoid fractures are rare and difficult in treating among shoulder fractures. With the development of research, a series of surgical approaches and methods were performed, such as anterior approach, traditional Judet approach, modified Judet approach, combined approach, acromion approach and so on. While these approaches still have some limitations in treatment of Ideberg III glenoid fractures with superior shoulder suspensory complex(SSSC) injury, for extensive soft tissue dissection, unsatisfactory exposure, difficult surgical intervention. In our case with Ideberg III glenoid fracture with acromioclavicular dislocation, superior approach was adopted during treatment of the scapula glenoid fracture and coracoclavicular ligament rupture perfectly. The result was satisfactory in accordance with 92 points by Constant-Murley score. We believe that individualized therapy should depend on the injury types, and superior approach would be a new valuable method for Ideberg III glenoid fractures with SSSC injury.
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Affiliation(s)
- JinLong Zheng
- Orthopedic Department of The Cilin Hospital, No 599, Shiji Road, Guanhaiwei Town, Cixi City, Zhe Jiang Province 315300, People's Republic of China
| | - Nan Lu
- Department of Orthopedic Surgery, Chang Zheng Hospital, The Second Military Medical University, No 415, Fengyang Road, Huangpu District, Shanghai 200003, People's Republic of China
| | - Zhuimeng Shen
- Orthopedic Department of The Cilin Hospital, No 599, Shiji Road, Guanhaiwei Town, Cixi City, Zhe Jiang Province 315300, People's Republic of China
| | - AiMin Chen
- Department of Orthopedic Surgery, Chang Zheng Hospital, The Second Military Medical University, No 415, Fengyang Road, Huangpu District, Shanghai 200003, People's Republic of China
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