Abstract
BackgroundSurgical treatment of scapular fractures with posterior approach is frequently associated with postoperative infraspinatus hypotrophy and weakness. The aim of this retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with the classic Judet versus modified Judet approach for scapular fracture.Patients and methods20 cases with scapular neck and body fracture treated with posterior approach for lateral border plate fixation were reviewed. In 11 of 20 cases, we used the modified Judet approach (MJ group), and in 9 cases we used the classic Judet approach (CJ group). All fractures were classified according to the AO classification system. At follow-up examinations, patients had X-ray assessment with acromiohumeral distance (AHD) measurement, clinical evaluation, active range of motion (ROM) examination, Constant Shoulder Score, and Disability of the Arm, Shoulder and Hand (DASH) Score. Infraspinatus strength assessment was measured using a dynamometer during infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT).ResultsDemographic data did not significantly differ between the CJ group and MJ group, except for mean follow-up, which was 4.15 years in the CJ group and 2.33 in the MJ group (p < 0.001). All X-ray examinations showed fracture healing. AHD was significantly decreased in the CJ group (p = 0.006). We did not find significant differences in active ROM between the MJ and CJ groups in the injured arm (p < 0.05). The Constant Score was 75.83 (±14.03) in the CJ group and 82.75 (±10.72) in the MJ group (p = 0.31); DASH Score was 10.16 in the CJ group and 6.25 in the MJ group (p = 0.49). IST showed mean strength of 8.38 kg (±1.75) in the MJ group and 4.61 kg (±1.98) in the CJ group (p = 0.002), ISRT test was 8.7 (±1.64) in the MJ group and 4.95 (±2.1) in the CJ group (p = 0.002). Infraspinatus hypotrophy was detected during inspection in six patients (five in the CJ group and one in the MJ group); it was related to infraspinatus strength weakness in IST and ISRT (p < 0.001).ConclusionsInfraspinatus-sparing surgical approach for scapular fracture avoids infraspinatus hypotrophy and external-rotation strength weakness. We suggest use of the modified Judet approach for scapular fracture and to restrict the classic Judet approach to only when the surgeon believes that the fracture is not easily reducible with a narrower exposure.Level of evidenceLevel IV.
Highlights
Infraspinatus hypotrophy was detected during inspection in six patients; it was related to infraspinatus strength weakness in infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT) (p < 0.001)
We suggest use of the modified Judet approach for scapular fracture and to restrict the classic Judet approach to only when the surgeon believes that the fracture is not reducible with a narrower exposure
Goss described the double lesion of the superior shoulder suspensory complex (SSSC); this condition is defined as lesions of any two structures among the ring composed by the glenoid process, coracoid process, coracoclavicular ligament, distal clavicle, acromioclavicular joint, and acromial process and creates a floating glenohumeral joint that requires operative management [5]
Summary
Scapula fracture represents a very small part of all fractures [1].According to Ada et al, fractures located in the glenoid neck and body account for 98 % of all fractures of the scapula, with other less common sites being the acromion, coracoid processes, and scapular spine [2].They are mostly caused by high-energy trauma and are frequently associated with spine, cranium, and thorax injuries [3].Development of new techniques has raised considerable interest in operative treatment, even though the vast majority of these fractures are treated conservatively; nowadays, 9.8 % of scapula fractures are treated surgically [4].Goss described the double lesion of the superior shoulder suspensory complex (SSSC); this condition is defined as lesions of any two structures among the ring composed by the glenoid process, coracoid process, coracoclavicular ligament, distal clavicle, acromioclavicular joint, and acromial process and creates a floating glenohumeral joint that requires operative management [5].The surgical indication should be primarily related to individual factors: functional demands, ipsilateral injuries, comorbidities, and hand dominance. According to Ada et al, fractures located in the glenoid neck and body account for 98 % of all fractures of the scapula, with other less common sites being the acromion, coracoid processes, and scapular spine [2]. They are mostly caused by high-energy trauma and are frequently associated with spine, cranium, and thorax injuries [3]. Surgical treatment of scapular fractures with posterior approach is frequently associated with postoperative infraspinatus hypotrophy and weakness The aim of this retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with the classic Judet versus modified Judet approach for scapular fracture
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