Which scapula fractures should we operate on and what are the functional outcomes?

Year 2023, Volume: 7 Issue: 2, 200 - 205, 29.10.2023

İbrahim Etli

https://doi.org/10.30565/medalanya.1358781

Abstract

Aim: In this study we reported the functional results and complications of patients with scapula fractures who underwent open reduction and internal fixation.

Methods: The study included 16 patients with scapula fractures who were treated with open reduction and internal fixation(ORIF) between September 2015 and March 2022. Radiologic examination (AP in the scapular plane, lateral and axillary radiography) and computed tomography (CT) scans were performed in all patients. Fractures were classified according to the revised (AO/OTA) classification system. The patients underwent deltopectoral and posterior approaches described by Judet. Functional outcomes were measured using Constant-Murley scores.

Results: Ten patients had a scapular neck fracture, or glenoid fossa fracture, five patients had a scapular trunk fracture affecting the glenohumeral joint, and one patient had a scapula process fracture. It was accompanied by clavicle shaft fracture in five patients. The mean follow-up period after injury was 42 months (6-92 months). The mean Constant-Murley score (CMS) for the shoulder with scapula fracture was 93.8 (±8.93).

Conclusion: Open reduction and internal fixation of displaced scapular fractures is an effective treatment option in terms of union rate and functional outcome.

Keywords

Scapula fractures, constant-murley score, judet approaches

Hangi skapula kırıklarını opere etmeliyiz ve fonksiyonel sonuçları nelerdir?

Abstract

Amaç: Bu çalışmada, skapula kırığı nedeniyle, açık redüksiyon ve internal tespit yapılan hastaların fonksiyonel sonuçlarını ve komplikasyonları araştırdık.

Yöntem: Çalışma, Eylül 2015 ile mart 2022 arasında skapula kırığı olan açık redüksiyon ve internal tespit (ARIF) ile tedavi edilen 16 hasta değerlendirildi.Radyolojik inceleme skapular planda AP,lateral,aksiller grafi ve bilgisayarlı tomografi (BT) ile yapıldı.Kırıklar revize edilmiş (AO/OTA) sınıflandırma sistemine göre sınıflandırıldı.Hastalara cerrahi teknik olarak deltopektoral ve Judet tarafından tarif edilen posterior yaklaşım uygulandı.Fonksiyonel sonuçlar, Constant-Murley skorları kullanılarak değerlendirildi.

Bulgular: On hastada skapula boyun kırığı,glenoid fossa kırığı, beş hastada glenohumeral eklemi etkileyen skapular gövde kırığı ve bir hastada skapula proçes kırığı vardı.Ayrıca beş hastada klavıkula cisim kırığı varidi.Takip süresi ortalama 42 ay (6-92 ay).Omuz Constant-Murley skoru(CMS)ortalama93.8(±8.93)di.

Sonuç:Yer değiştirmiş skapular kırıkların açık redüksiyonu ve internal fiksasyonu , kaynama oranı ve fonksiyonel sonuç açısından etkili bir tedavi seçeneğidir.
Anahtar Kelimeler:

Keywords

Skapula kırığı, Constant -Murley skoru, Judet yaklaşımı

References

• 1. Mc Ginnis M, Denton JR. Fractures of the scapula: a retrospective study of 40 fractured scapulae.The Journal of Trauma: Injury, Infection, and Critical Care 1989; 29(11): 1488-93.
• 2. Gosens T, Speigner B, Minekus J. Fracture of the scapular body: functional outcome after conservative treatment. J Shoulder Elbow Surg. 2009 May-Jun;18(3):443-8. doi: 10.1016/j.jse.2009.01.030.
• 3. Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Injury. 2012 Mar;43(3):327-33. doi: 10.1016/j.injury.2011.09.029.
• 4. Tatro JM, Schroder LK, Molitor BA, Parker ED, Cole PA. Injury mechanism, epidemiology, and Hospital trends of scapula fractures: A 10-year retrospective study of the National Trauma Data Bank. Injury. 2019 Feb;50(2):376-381. doi: 10.1016/j.injury.2019.01.017.
• 5. Cole PA. Scapula fractures. Orthop Clin North Am. 2002 Jan;33(1):1-18, vii. doi: 10.1016/s0030-5898(03)00069-5.
• 6. Tatro JM, Gilbertson JA, Schroder LK, Cole PA. Five to Ten-Year Outcomes of Operatively Treated Scapular Fractures. J Bone Joint Surg Am. 2018 May 16;100(10):871-878. doi: 10.2106/JBJS.17.00673.
• 7. Esenkaya İ, Ünay K. Anatomical frame plate osteosynthesis in Ada-Miller Type 2 or 4 scapula fractures. Acta Orthop Traumatol Turc. 2011;45(3):156-61. doi: 10.3944/AOTT.2011.2584.
• 8. Anavian J, Gauger EM, Schroder LK, Wijdicks CA, Cole PA. Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures. J Bone Joint Surg Am. 2012 Apr 4;94(7):645-53. doi: 10.2106/JBJS.J.00896.
• 9. Schroder LK, Gauger EM, Gilbertson JA, Cole PA. Functional Outcomes After Operative Management of Extra-Articular Glenoid Neck and Scapular Body Fractures. J Bone Joint Surg Am. 2016 Oct 5;98(19):1623-1630. doi: 10.2106/JBJS.15.01224.
• 10. Cole PA Jr, Gilbertson JA, Cole PA Sr. Functional Outcomes of Operative Management of Scapula Fractures in a Geriatric Cohort. J Orthop Trauma. 2017 Jan;31(1):e1-e8. doi: 10.1097/BOT.0000000000000710.
• 11. Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg. 2012 Mar;20(3):130-41. doi: 10.5435/JAAOS-20-03-130. PMID: 22382285.
• 12. Vander Voort W, Wilkinson B, Bedard N, Hendrickson N, Willey M. The Operative Treatment of Scapula Fractures: An Analysis of 10,097 Patients. Iowa Orthop J. 2022 Jun;42(1):213-216. PMID: 35821957; PMCID: PMC9210424.
• 13. Aslan A. [Systematic Reviews and Meta-Analyses]. Acta Med. Alanya 2018;2(2):62- 63. DOI: 10.30565/medalanya.439541
• 14. Aslan A. [Evidence Based Medicine and Clinical Practise Guidlines]. Acta Med. Alanya 2018;1(1):1-2. DOI: 10.30565/medalanya.405333