POSTERIOR MINIMALLY INVASIVE APPROACH FOR RECONSTRUCTION OF SCAPULA OF FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HEQiang ¹ ,  JIAJian ² , ZHANGYu ³

1. Graduate School of Tianjin Medical University, Tianjin, 300070, P. R. China;
2. Department of Orthopedics, Tianjin Hospital, Tianjin, 300070, P. R. China;
3. Department of Joint Surgery, Tianjin Union Medical Center, Tianjin, 300070, P. R. China;

Corresponding?author：

JIAJian, Email: jiajian1969@yahoo.com.cn

Keywords：

Posterior minimally invasive approach; Internal fixation; Scapula fracture

DOI：

10.7507/1002-1892.20140176

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Objective To investigate the effectiveness of posterior minimally invasive approach for internal fixation of displaced scapula fractures. Methods Between January 2006 and December 2011,16 patients with scapular fractures underwent surgical fixation by a minimally invasive approach,including 11 cases of displaced glenoid fractures and 5 cases of unstable scapular neck/body fractures.There were 12 males and 4 females,aged 35-69 years (mean,53 years).The causes of injury were traffic accident in 10 cases,falling from height in 4 cases,and tumble in 2 cases.In 11 cases of displaced glenoid fractures,6 were rated as Ideberg type Ⅱ,2 as Ideberg type Ⅲ,1 as Ideberg type IV,and 2 as Ideberg type V,with a fracture displacement of more than 3 mm.In 5 cases of unstable scapular neck/body fractures,there were 3 cases of scapular neck fractures and 2 cases of scapular body fractures,with a fracture end angulation of more than 20°;3 cases had floating shoulder injury.The interval of injury and operation was 4-14 days (mean,6 days). Results The mean operation time was 105.8 minutes;the mean intraoperative blood loss was 105.8 mL,and the mean hospitalization time was 17.6 days.Three patients had inflammation around the surgical incision,which was controlled by change dressing;primary healing of incision was obtained in the others.The patients were followed up 12-36 months (mean,24 months);all fractures healed within 12-19 weeks (mean,15.8 weeks).There was no implant failure or deep infection.Constant shoulder score,disability of the arm,shoulder,and hand (DASH) score,and visual analogue scale (VAS) score at post-operation had a significant improvement when compared with scores at pre-operation (P<0.05),but no significant difference was found between different time points at post-operation (P>0.05).Shoulder joint activities were gradually restored during the follow-up;the shoulder range of motion in elevation,abduction,internal rotation,and external rotation at 12 months after operation and last follow-up were significantly higher than those at 6 months after operation (P<0.05),but difference was not significant between at 12 months and last follow-up (P>0.05). Conclusion Posterior minimally invasive approach for internal fixation has good effectiveness in treating displaced scapula fractures,with the advantages of no need for a large subcutaneous flap and an extensive Judet incision or creation of muscular flaps.

Citation： HEQiang, JIAJian, ZHANGYu. POSTERIOR MINIMALLY INVASIVE APPROACH FOR RECONSTRUCTION OF SCAPULA OF FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 793-797. doi: 10.7507/1002-1892.20140176 Copy

1.	Lantry JM,Roberts CS,Giannoudis PV.Operative treatment of scapular fractures:a systematic review.Injury,2008,39(3):271-283.
2.	Cole PA,Dubin JR,Freeman G.Operative techniques in the management of scapular fractures.Orthop Clin North Am,2013,44(3):331-343,viii.
3.	Pizanis A,Tosounidis G,Braun C,et al.The posterior two-portal approach for reconstruction of scapula fractures:results of 39 patients.Injury,2013,44(11):1630-1635.
4.	Jones CB,Cornelius JP,Sietsema DL,et al.Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures.J OrthoP Trauma,2009,23(8):558-564.
5.	Obremskey WT,Lyman JR.A modified judet approach to the scapula.J OrthoP Trauma,2004,18(10):696-699.
6.	Ideberg R,Grevsten S,Larsson S.Epidemiology of scapular fractures.Incidence and classification of 338 fractures.Acta OrthoP Scand,1995,66(5):395-397.
7.	Ban I,Troelsen A,Christiansen DH,et al.Standardised test protocol (Constant Score) for evaluation of functionality in patients with shoulder disorders.Dan Med J,2013,60(4):A4608.
8.	Angst F,Schwyzer HK,Aeschlimann A,et al.Measures of adult shoulder function:Disabilities of the Arm,Shoulder,and Hand Questionnaire (DASH) and its short version (QuickDASH),Shoulder Pain and Disability Index (SPADI),American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form,Constant (Murley) Score (CS),Simple Shoulder Test (SST),Oxford Shoulder Score (OSS),Shoulder Disability Questionnaire (SDQ),and Western Ontario Shoulder Instability Index (WOSI).Arthritis Care Res (Hoboken),2011,63 Suppl 11:S174-188.
9.	Hawker GA,Mian S,Kendzerska T,et al.Measures of adult pain:Visual Analog Scale for Pain (VAS Pain),Numeric Rating Scale for Pain (NRS Pain),McGill Pain Questionnaire (MPQ),Short-Form McGill Pain Questionnaire (SF-MPQ),Chronic Pain Grade Scale (CPGS),Short Form-36 Bodily Pain Scale (SF-36 BPS),and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).Arthritis Care Res (Hoboken),2011,63 Suppl 11:S240-252.
10.	王勇,許兵,吳銀生,等.直切口與 Judet入路治療肩胛骨頸部及體部骨折的對比研究.中華骨科雜志,2013,33(10):1018-1023.
11.	Schandelmaier P,Blauth M,Schneider C,et al.Fractures of the glenoid treated by operation.A 5to 23-year follow-uP of 22 cases.J Bone Joint Surg (Br),2002,84(2):173-177.
12.	Euler E,Habermeyer P,Kohler W,et al.Scapula fractures-classification and differential therapy.Orthopade,1992,21(2):158-162.
13.	Yadav V,Khare GN,Singh S,et al.A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle.Bone Joint J,2013,95-B(6):815-819.
14.	Izadpanah K,Jaeger M,Maier D,et al.The floating shoulder-clinical and radiological results after intramedullary stabilization of the clavicle in cases with minor displacement of the scapular neck fracture.J Trauma Acute Care Surg,2012,72(2):E8-13.
15.	Lyons RP.Open reduction and internal fixation of os acromion fracture-separation as a component of a floating shoulder injury:a case report.J Shoulder Elbow Surg,2010,19(7):e18-21.
16.	楊凱,屈鐵男,薛清佩,等.后入路手術治療肩胛骨骨折 14 例療效觀察.中國矯形外科雜志,2008,16(22):1692-1694.
17.	Wiedemann E.Fractures of the scapula.Unfallchirurg,2004,107(12):1124-1133.

1. Lantry JM,Roberts CS,Giannoudis PV.Operative treatment of scapular fractures:a systematic review.Injury,2008,39(3):271-283.
2. Cole PA,Dubin JR,Freeman G.Operative techniques in the management of scapular fractures.Orthop Clin North Am,2013,44(3):331-343,viii.
3. Pizanis A,Tosounidis G,Braun C,et al.The posterior two-portal approach for reconstruction of scapula fractures:results of 39 patients.Injury,2013,44(11):1630-1635.
4. Jones CB,Cornelius JP,Sietsema DL,et al.Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures.J OrthoP Trauma,2009,23(8):558-564.
5. Obremskey WT,Lyman JR.A modified judet approach to the scapula.J OrthoP Trauma,2004,18(10):696-699.
6. Ideberg R,Grevsten S,Larsson S.Epidemiology of scapular fractures.Incidence and classification of 338 fractures.Acta OrthoP Scand,1995,66(5):395-397.
7. Ban I,Troelsen A,Christiansen DH,et al.Standardised test protocol (Constant Score) for evaluation of functionality in patients with shoulder disorders.Dan Med J,2013,60(4):A4608.
8. Angst F,Schwyzer HK,Aeschlimann A,et al.Measures of adult shoulder function:Disabilities of the Arm,Shoulder,and Hand Questionnaire (DASH) and its short version (QuickDASH),Shoulder Pain and Disability Index (SPADI),American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form,Constant (Murley) Score (CS),Simple Shoulder Test (SST),Oxford Shoulder Score (OSS),Shoulder Disability Questionnaire (SDQ),and Western Ontario Shoulder Instability Index (WOSI).Arthritis Care Res (Hoboken),2011,63 Suppl 11:S174-188.
9. Hawker GA,Mian S,Kendzerska T,et al.Measures of adult pain:Visual Analog Scale for Pain (VAS Pain),Numeric Rating Scale for Pain (NRS Pain),McGill Pain Questionnaire (MPQ),Short-Form McGill Pain Questionnaire (SF-MPQ),Chronic Pain Grade Scale (CPGS),Short Form-36 Bodily Pain Scale (SF-36 BPS),and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).Arthritis Care Res (Hoboken),2011,63 Suppl 11:S240-252.
10. 王勇,許兵,吳銀生,等.直切口與 Judet入路治療肩胛骨頸部及體部骨折的對比研究.中華骨科雜志,2013,33(10):1018-1023.
11. Schandelmaier P,Blauth M,Schneider C,et al.Fractures of the glenoid treated by operation.A 5to 23-year follow-uP of 22 cases.J Bone Joint Surg (Br),2002,84(2):173-177.
12. Euler E,Habermeyer P,Kohler W,et al.Scapula fractures-classification and differential therapy.Orthopade,1992,21(2):158-162.
13. Yadav V,Khare GN,Singh S,et al.A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle.Bone Joint J,2013,95-B(6):815-819.
14. Izadpanah K,Jaeger M,Maier D,et al.The floating shoulder-clinical and radiological results after intramedullary stabilization of the clavicle in cases with minor displacement of the scapular neck fracture.J Trauma Acute Care Surg,2012,72(2):E8-13.
15. Lyons RP.Open reduction and internal fixation of os acromion fracture-separation as a component of a floating shoulder injury:a case report.J Shoulder Elbow Surg,2010,19(7):e18-21.
16. 楊凱,屈鐵男,薛清佩,等.后入路手術治療肩胛骨骨折 14 例療效觀察.中國矯形外科雜志,2008,16(22):1692-1694.
17. Wiedemann E.Fractures of the scapula.Unfallchirurg,2004,107(12):1124-1133.

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POSTERIOR MINIMALLY INVASIVE APPROACH FOR RECONSTRUCTION OF SCAPULA OF FRACTURES

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