Scapular Neck Fractures Research Articles

Functional outcomes of extra-articular scapula fracture fixation with distal humeral Y-type locking plate: a retrospective study

BackgroundThis study aimed to compare the functional outcomes of the Y-type locking plate with the straight reconstruction locking plate for severe displaced scapular fractures.MethodsThis was a retrospective cohort study of 37 patients with severe displaced scapular body and neck fractures treated between July 2013 and October 2016 at the Hanzhong Central Hospital. Treatment selection was based on the surgeon’s experience and discussion with the patient. Sixteen patients received Y-type locking plates and 21 patients received straight reconstruction locking plates. The primary indexes were the Constant Shoulder Function (CSF) and Disabilities of the arm, shoulder, and hand (DASH) scores at 3, 6, and 12 months.ResultsThere were 32 males and five females. Mean age was 46.0 ± 10.0 years. The cause of injury included car accident, fall, high fall, and bruising. At 3 months, compared with the straight reconstruction locking plate group, the Y-type locking plate group showed higher CSF scores (82.9 ± 3.5 vs. 79.3 ± 4.4, P = 0.01) and lower DASH scores (9.5 ± 2.5 vs. 12.7 ± 3.9, P = 0.008). There were no differences at 6 and 12 months. There were no differences between the two groups regarding intraoperative blood loss (P = 0.65) and operation time (P = 0.634). There were no complications such as plate rupture and screw prolapse during the 1-year follow-up.ConclusionsOpen reduction using the distal humeral Y-type locking plate can achieve better short-term functional outcomes (3 months) than the straight reconstruction locking plate for severe displaced scapular body and neck fractures, but outcomes are similar at 6 and 12 months. Level of evidence: II-2.

Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures in Adults

AbstractBackground: Fracture clavicle is one of the most common fractures, it constitutes about 4% of all fractures. 76% of clavicular fractures are fracture of the mid shaft. Clavicular fractures have classically been treated conservatively with favourable results. However, unsatisfactory results were found in recent clinical series as nonunion and malunion. The debate is still present between conservative and operative treatment of displaced fracture clavicle. This study is meant to compare the outcomes of nonoperative conservative treatment and operative treatment with plate fixation of the completely displaced midshaft clavicular fractures to clarify the merits and possible disadvantages of each method.Aim of Study: Comparison between the outcomes of the non-operative and operative treatment of displaced mid-shaft clavicular fracture to reveal the advantages and disadvantages of each method to refine the indications of each method.Patients and Methods: This study was performed on fourty adult patients with mid-shaft clavicular fracture, sub grouped randomly in two matched groups regarding age, sex and type of fracture. 20 patients (Group A) were treated non-operatively by immobilization with broad arm sling and 20 patients (Group B) were treated operatively by open reduction and internal fixation (ORIF) with plate and screws. Patients were collected from orthopedic surgery department, Tanta University Hospitals, followed up at a period of 18 months and assessed using the constant shoulder score (CSS).Results: Results were functionally satisfactory in 90% of group A patients and in 70% of group B patients according to CSS. ORIF was attended with higher complication rate, inferior overall outcome and more unsatisfied patients.Conclusions: According to the study results, non-operative treatment by broad arm sling is the preferred line of treatment in solitary closed uncomplicated mid-shaft clavicular fractures. ORIF is recommended in cases of associated scapular neck fracture “floating shoulder”.

A retrospective analysis of extra articular glenoid neck fracture of scapula (A study of 20 cases)

Introduction: Since long ago the scapula fracture is treated conservatively and most of time it works because scapula is a flat bone and coated with bulky muscle. So, nonunion of the fracture is usually not a problem, and most of time, due to very high arc of motion of shoulder joint, even in malunited fractures, mild to moderate restriction of the range of motion not create significant problem. But the actual problem comes when fracture through the glenoid neck or glenoid fossa cause derangement in the biomechanics of shoulder joint, or associated fracture of clavicle – ‘The floating shoulder’ cause significant instability of shoulder joint. Recent advances and proper understanding of the biomechanics of the shoulder joints open a new chapter of operative management for better quality of life.In this study we retrospectively tried to understand that which fractures can be treated conservatively and which one require fixation.Aim: To study retrospectively extraarticular glenoid neck fractures of scapula (a study of 20 cases).Materials and Methods: Total 20 patients having extra articular scapular neck fracture, with following criteria are included in this study. All patients were treated by consultant orthopedic surgeons of the department of orthopedics of Guru Gobindsingh Hospital, Jamnagar only. All patients are evaluated retrospectively. Patients having fracture of appendicles (Fracture of acromion, coracoid and spine), body as well as intra articular glenoid fracture were not included in this study. So this study was concerned only with stable and unstable scapular neck fracture. All patients are evaluated with Herscovici shoulder scoring system to make this study comparable with other study universally.Results: Our study shows excellent results in 16 out of 20 scapular fractures as well as 4 good results, according to Herscovici shoulder scoring system. Most common complication is subacromial pain especially at night while sleeping on that side. Incidence of mild exertional pain is 45% while loss of useful abduction was 10% and superficial infection is 5%.Conclusion: To conclude, this rare type of fracture has high incidence of significant associated injury. Among all scapular fractures extra articular displaced glenoid fracture and floating shoulder type injury should get special attention regards of its treatment, because closed observation and intelligence can make vast change in its outcome.

Mechanical testing of scapular neck fracture fixation using a synthetic bone model

BackgroundTrauma can fracture the scapular neck. Typically, a single plate along the lateral scapula border affixes the glenoid fragment to the scapula. This method is limited by difficulty in screw placement, frequent excessive soft tissue dissection, and risk for neurovascular injury. Substituting 2 smaller plates bridging the scapular neck mitigates these limitations, but no comparative mechanical data between techniques exists. Therefore, we compared the mechanical properties of two constructs securing a simulated scapular neck fracture. MethodsTwenty synthetic human scapulae underwent a templated scapular neck fracture. Repairs were performed with a single plate on the lateral scapular border (Column method), or two small plates parallel to the lateral border (Neck method). Measures of displacement, force, and stiffness were quantified during cyclic testing (20–150 N, 1 Hz, 1000 cycles) and loading to failure. Statistical comparisons were made with t-tests (p ≤ 0.050). FindingsThe column constructs had higher displacements than neck constructs after 1000 cycles, but differences were small (mean) 0.18 (SD 0.01) vs. 0.15 (0.02) mm (p ≤ 0.004). Cyclic stiffness was 655 (43) and 790 (88) N/mm for the column and neck constructs, respectively (p ≤ 0.003). Both techniques performed comparably in failure loading: at 1 mm of gap reduction the compressive loads were 426 (61) N and 428 (48) N and stiffness was 354 (129) and 334 (80) N/mm for the column and neck constructs, respectively. InterpretationGiven the surgical advantages, the neck fixation may be more suitable without biomechanical compromise compared to traditional lateral column fixation.

Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference?

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.

Epidemiological survey of scapular neck fractures between the east and west areas in China from 2010 through 2011

Objective To compare the epidemiological characteristics of glenoid fractures between the east and west areas in China from 2010 through 2011. Methods The data of glenoid fractures treated between January 2010 and December 2011 at 35 east hospitals and 28 west ones in China were analyzed retrospectively. The patients’ gender, age and type of Ideberg classification were documented. The data from the 35 east hospitals were classified as group A while those from the 28 west ones as group B. Comparisons were made to find out the general epidemiological characteristics. Results A total of 347 glenoid fractures were collected. The total male/female ratio was 2.69∶1. The glenoid fractures predominated in 2 age ranges from 41 to 50 years and from 51 to 60 years (19.60%). According to the Ideberg classification, there were 75 cases (21.61%) of type Ⅰ, 152 ones (43.80%) of type Ⅱ, 27 ones (7.78%) of type Ⅲ, 20 ones (5.76%) of type Ⅳ, 46 ones (13.26%) of type Ⅴ and 27 ones (7.78%) of type Ⅵ. The male/female ratio was 2.80∶1 in group A of 228 patients and 2.50∶1 in group B of 119 patients. The median age of group A was 47 years old and that of group B 44 years old. The differences were not statistically significant in male/female ratio, median age or distribution of age between the 2 groups (P>0.05). The fractures predominated in the age range from 51 to 60 years old (23.68%) in group A and in the age range from 31 to 40 years old (21.85%) in group B. The most frequent fracture type was type Ⅱ in both groups, accounting for 41.23% and 48.74% respectively. There was a significant difference between the 2 groups in distribution of Ideberg classification (P< 0.05). Conclusions The peak age of glenoid fractures was from 41 to 60 years, the high-risk type was Ideberg type Ⅱ and there were more male patients than female ones. The proportion of Ideberg type Ⅴ in the east area was higher than that in the west area. Key words: Shoulder fractures; Epidemiology studies; Small-area analysis; Sex distribution; Age distribution

Clinical efficacy of internal fixation through posterior minimally invasive approach for treatment of unstable scapula fractures

Objective To investigate the clinical efficacy of internal fixation through posterior minimally invasive approach in treating unstable scapula fractures. Methods A retrospective case control study was conducted on the clinical data of 36 patients with scapular fractures admitted between May 2011 and August 2016. There were 30 males and six females, with average age of 51.5 years (range, 46-64 years). According to Hardegger classification, there were 18 patients with scapular body fracture, 14 with scapular neck fracture, and four with glenoidal fracture. According to operation method, the patients were divided into Group A (n=24) which adopted internal fixation through posterior minimally invasive approach and Group B (n=12) which adopted the conventional Judet approach for internal fixation. The incision length, operation time, intraoperative bleeding, fracture healing time, Hardegger standard of clinical effects, and complications in two groups were compared. Results All patients were followed up for average 18 months (range, 6-24 months). The total length of surgical incision was (12.50±4.50)cm in Group A and (27.95±5.20)cm in Group B (P<0.05); the operation time was (86.5±11.5)minutes in Group A and (120.6±10.9)minutes in Group B (P<0.05); the intraoperative bleeding was (200.0±20.0)ml in Group A and (420.0±20.0)ml in Group B (P<0.05); fracture healing time was (10.0±1.0)weeks in Group A (12.0±1.5)weeks in Group B (P<0.05). According to Hardegger standard, in Group A, 15 patients were excellent, six good, and two fair, with an excellent and good rate of 91%; while in Group B, six patients were excellent, three good, two fair, and one poor, with an excellent and good rate of 75% (P<0.05). No complications were observed in Group A. In Group B, one patient with hematoma and one patient with nonunion of incision area were observed, both of which recovered after drainage and dressing change. One patient with superior scapular nerve injury was found and recovered after treatment. The incidence of complications was 25% in Group B, higher than 0 in Group A (P<0.05). There was no internal fixation fracture or nonunion in two groups. Conclusion Compared with the conventional Judet approach, minimally invasive internal fixation approach in the treatment of unstable scapula fracture demonstrates the advantages of mild trauma, faster functional restoration, and fewer complications. Key words: Scapula; Fracture fixation, internal; Surgical procedures, minimally invasive

English

INTRODUCTION: Clavicular fractures are common injuries, accounting for 2.6% of all fractures. Fractures of the middle third (or midshaft) account for approximately 80% of all clavicular fractures. The traditional view that the vast majority of clavicular fractures heal with good functional outcomes following non-operative treatment is no longer valid. Recent studies have identified a higher rate of nonunion and specific deficits of shoulder function in subgroups of patients with this injuries. These fractures should therefore be viewed in the spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualized treatment and when indicated these fractures should be treated by primary operative fixation. AIM OF THE STUDY: The aim of the study is to “prospectively analyse the functional outcome of clavicle fractures treated by Plate Osteosynthesis” in terms of complications and functional outcome in indicated cases. MATERIALS AND METHODS: Study is conducted in Madurai Medical College and Government Rajaji Hospital on 20 patients with displaced/comminuted midshaft clavicle fractures from May 2010 to Dec 2011. All the patients were treated by open reduction and internal fixation with 3.5 reconstruction plate and screws. Inclusion Criteria - Patients were included in the study if they had (1) a completely displaced (>2cms) mid shaft fracture of the clavicle (derived by clinical measurement), (2) a comminuted middle third fracture of the clavicle with inferior cortical defect, (3) a clavicle fracture associated with scapular neck fracture (floating shoulder), (4) painful non-union, (5) an age between sixteen and sixty years, (6) no medical contraindications to general anesthesia, and (7) informed consent. Exclusion Criteria - Patients were excluded from the study if they had (1) an age of less than sixteen years or greater than sixty years, (2) a fracture in the proximal or distal third of the clavicle, (3) Pathological fractures, (4) Undisplaced or minimally displaced clavicle fractures. A sling was used for comfort for seven to ten days, and then active range-ofmotion exercises were allowed. When fracture union (defined as radiographic union with no pain or motion with manual stressing of the fracture) was evident, typically at six weeks, overhead abduction and strengthening were allowed, with a return to full activities at three months. RESULTS: Of the twenty patients (19 male and 1 female and most of them aged below 30 years) studied between May 2010 and Dec 2011, all had primary plate fixation except the one with painful non-union for whom plate osteosynthesis with bone grafting was done. Three patients were lost to follow-up and remaining 17 patients had a mean of 15.5 months follow-up. All seventeen patients had fracture union in a mean of 16 weeks. Most of the patients (82%) had constant shoulder score above 90 with an excellent grade except for three patients. Of these, two of them had wound infection and function improved after implant removal; and one patient was a 60 year old lady who developed shoulder stiffness due to improper follow-up and physiotherapy. CONCLUSION: The traditional view that the vast majority of clavicular fractures heal with good functional outcomes following nonoperative treatment is no longer valid. Recent studies have identified a higher rate of non-union, late neurovascular compromise and specific deficits of shoulder function in subgroups of patients with these injuries who are treated by conservative means. Internal fixation by plate osteosynthesis has the advantage of early pain resolution, early return of shoulder function and potentially early return to work. The encountered complications in our study were similar to other recent studies. Clavicle fractures should therefore be viewed as a spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualized treatment, and plate osteosynthesis should be preferred for the treatment of indicated middle-third clavicle fractures in active individuals.

The floating shoulder: Ipsilateral clavicular and scapular neck fractures treatment by different methods

Introduction: Double disruptions of the superior suspensory shoulder complex (SSSC) resulting in ipsilateral mid shaft clavicular and scapular body/neck fractures, are commonly referred to as a ‘floating shoulder’ injury. If not treated properly, this could lead to malunion, drooping shoulder deformity, shoulder pain and weakness, subacromial impingement syndrome, traumatic arthritis, and even delayed nerve and vascular damage and other complications. Materials and Methods: This is a retrospective type of study of 15 cases of floating shoulder injury treated by different surgical methods. All the cases were operated electively on regular operation theatre days. Results: The age range in total 15 patients was from 22 years to 62 years with mean age at the time of injury was 40.4 years. Out of 15 cases 12 (80%) were males and 3(20%) were females. High energy trauma in 12(80%) cases, fall from height in 2(13.3%) cases and fall of heavy metal object in one (6.6%) case. Associated injuries in the form of rib fractures with haemothorax in 5(33.3%) cases, head injury in 3 (20%) cases, tibial shaft fracture in one(6.6%) case and tibial spine avulsion in one (6.6%) case. Total of 7(46.6%) cases treated with only clavicle fixation, 5(33.3%) cases with both scapula and clavicle fixation and 3(20%) cases treated conservatively. Mean Herscovici score was 12.4 with excellent results in 4, good in 6, fair in 3 and poor in 2 cases. Conclusion: Significant displacement at one or both fracture sites of floating shoulder injury can result in a poor functional outcome which can be improved with surgical intervention. Conservative management with acceptable results reserved for patients with minimally-displaced fractures.

Treatment of scapular fractures with lateral incision and bridge combined internal fixation system

To investigate the clinical results of scapula fractures with lateral incision combined with bridge internal fixation system. From October 2012 to December 2016, 20 cases of scapular fractures were treated through the lateral incision combined with bridge fixation system, including 15 males and 5 females, with an average age of 31.6 years old(ranged, 21 to 52 years old). Fourteen cases were scapular body fracture, 10 were scapular neck fracture, 6 were scapular fracture, 1 was acromion fracture, 1 was coracoid fracture, 4 were the glenoid rim fracture, 3 were the glenoid fossa fracture. The operation time ranged from 4 to 15 d after injury with an average of 10 d. All 20 cases were followed up for 3 to 24 months with an average of 15 months. Wound infection occurred in 2 cases after operation, and was healed after wound debridement and change dressing; no osteomyelitis, iatrogenic nerve injury, breakage of internal fixation, fracture displacement, joint stiffness occurred. Callus growth was observed at the fracture site 3 months after operation, the fracture healing time was 4 to 7 months, fracture healing was good without delayed union or malunion. According to Hardegger shoulder score, the results were excellent in 12 cases, good in 6 cases, moderate in 2 cases. Lateral incision approach combined with bridge internal fixation system for scapula fractures has the advantages of easy operation, revealed clearly, and the incision can be arbitrary to extend on both sides, to provide favorable conditions for the reduction and fixation of fracture. Bridge combined internal fixation system has the advantages of flexible operation, reliable fixation strength, is a good choice for treatment of scapula fracture.

Fractures of the scapula

Although scapular fractures only occur infrequently, the anatomical location of the scapula means that it is critical for thoracic limb function, therefore appropriate treatment is essential in maintaining limb function. The scapula has a substantial protective soft tissue envelope and considerable trauma is required to fracture it; consequently a high proportion of patients suffer concurrent injuries that may take precedence for management on initial presentation. Scapular fractures are generally classified as stable extra-articular, unstable extra-articular and intra-articular, with surgical treatment being advised for the latter two categories. Cases for which conservative management is appropriate carry an excellent prognosis, as healing generally occurs quickly and shoulder function is often restored even in cases of malunion. Open reduction and internal fixation is employed for some scapular body and spine fractures, fractures of the acromion, most fractures of the scapular neck, fractures of the supraglenoid tuberosity and fractures of the glenoid. The prognosis following scapular body fracture repair is generally excellent, the prognosis for scapular neck fractures is good to excellent, while the prognosis for articular fractures may be poorer, with the majority of dogs regaining function but with a persistent lameness associated. Salvage options are rarely required following scapular fracture, but include shoulder arthrodesis, excision arthroplasty and partial scapulectomy.

Management of floating shoulder injury with dual surgical approach

Background: The floating shoulder is an uncommon but important injury pattern. Although it is frequently defined as an ipsilateral fracture of the clavicle and scapular neck, studies suggest that ligament disruption associated with a scapular neck fracture contributes to the functional equivalent of this injury pattern, with or without an associated clavicle fracture. Minimally displaced fractures typically do well with nonsurgical care. However, the degree of fracture displacement and ligament disruption that results in less predictable outcomes after nonsurgical treatment is uncertain. Internal fixation of a displaced clavicle fracture restores the contour of the shoulder, regulates soft-tissue tension, but it does not reduces the scapular neck fracture. Hence fixation of both fractures is recommended in certain fracture patterns. Material & Methods: This is a study of 10 cases of floating shoulder injury operated by front (ant. Approach for # clavicle) and back (modified Judets posterior approach for scapula #) from Jan 2012 to March 2016. All cases were assessed with Constant shoulder score at the end of six months. Results: Results of our study shows that majority of pt. had excellent to good results. There were complications in two cases; 1.Broken Clavicle plate which needed revision, 2.Failure to anatomically reduce scapula neck fracture and proximal screw penetration in to the joint. Conclusion: We propose the combined anterior and posterior surgical approach to be the method of choice for the treatment of unstable and displaced floating shoulder injuries.

Is radiograph glenopolar angle accurate for extraarticular scapular neck fractures?

BackgroundPlain radiographs still play a role in management of extraarticular scapular neck fractures. Glenopolar angle (GPA) is one of the radiograph measurements that is used to determine the necessity for surgery. Our aim was to establish reliability of GPA on plain radiograph in patients with extraarticular scapular neck fractures. MethodsWe performed a multicentre retrospective study including all patients with extraarticular scapular neck fractures with available imaging between 2006 and 2012. We excluded intra-articular glenoid fractures, scapular blade fractures, acromion fractures, and scapular spine fractures. We compared GPA on plain radiograph with three dimensional computed tomography (3D CT) measurement, as well as contribution of radiograph rotational error, glenoid inclination, and medial shortening of glenoid fragment towards GPA measurement. ResultsOne hundred patients met the inclusion criteria. The mean difference between the GPA measurements on radiographs and 3D CT was 6.1±0.85° (95% confidence interval) as an absolute value. In terms of contribution to GPA values, GPA changed by one degree with ten degrees of radiograph rotational error, three degrees of glenoid inclination, and three millimetres of glenoid fragment medial shortening. ConclusionPlain radiograph can provide a clinician with a reasonable estimation of the GPA. Glenoid inclination has a greater influence on GPA compared to medial shortening.

Fixation of a complete scapular neck fracture in a foal using two 3.5 mm locking compression plates

SummaryThis report describes the successful surgical repair of a transverse, displaced scapula fracture in a foal. A 3.5 mm locking compression plate (LCP) was used on either side of the spine of the scapula. The suprascapular nerve was apparent upon dissection as it passed directly over the fracture line and care was taken to leave it intact, although the fracture line itself caused some irritation. The foal recovered without long‐term nerve damage and is sound at 1.5 years post surgery.

Epidemiological analysis of scapular neck fractures in the Third Affiliated Hospital to Hebei Medical University from 2003 through 2012

Objective To analyze the epidemiological features and trends of scapular neck fractures from 2003 through 2012 in our hospital. Methods The clinical data were collected of the patients with scapular neck fractures who had been treated between January 2003 and December 2012 in our hospital. The patients' gender, age and fracture type of Miller classification were documented. The data from January 2003 to December 2007 were assigned into group A and those from January 2008 to December 2012 into group B. The 2 groups were compared to find out the general epidemiological characteristics and trends in the recent 10 years. Results A total of 424 patients with scapular neck fractures were collected, including 333 males and 91 females. The total male/female ratio was 3.66:1. The scapular neck fractures predominated in an age range of 41 to 50 years (24.53%). According to Miller classification, there were 144 cases (33.96%) of type I, 230 ones (54.25%) of type Ⅱ and 50 ones (11.79%) of type Ⅲ.344 cases (81.13%) were stable fractures and 80 ones (18.87%) unstable fractures. The male/female ratio was 3.85: 1 in group A of 189 patients and 3.52: 1 in group B of 235 patients. The mean age of group A was 37.8±14.8 years and that of group B 39.3±15.7 years. There were no significant differences between the 2 groups in male/female ratio, mean age, distribution of age or Miller classification (P > 0.05). Conclusions The peak age of scapular neck fractures was from 41 to 50 years. There was an increasing trend in the mean age. There were more male patients than female ones. The high-risk type was Miller type Ⅱ and stable fractures were more common. Key words: Scapular neck; Fractures, bone; Epidemiology; Miller classification

3-D Printing Technique to Aid Surgical Planning in Treatment of Floating Shoulder Injury: A Case Report

Background: According to the published literature, Ipsilateral displaced clavicle and scapular neck fractures, also called floating shoulder injury (FSI), can be managed conservatively or surgically; however, the therapeutic option for this rare injury remains controversial. Case Description: We presented a 18-year-old male patient who suffered FSI of the right shoulder. A threedimensional (3D) impression of the injured shoulder joint was obtained to plan the operation. The patient was operated by open reduction and plate internal fixation (ORIF) of the fractures with the aid of 3-D printing model. Literature Review: Our literature review included various treatments associated with FSI. We identified that no previous reports of floating shoulders treated by ORIF with the aid of 3-D printing technique. Purposes and Clinical Relevance: This report illustrates the practicability of 3-D printing technique in surgical treatment, which could enhance the surgeon’s understanding the trauma of FSI, resulting in increased surgery precision and decreased trauma.

Floating shoulder with the lateral clavicular fragment impinging on parietal pleura: A case report

In ipsilateral mid-clavicular and scapular-neck fractures, the mechanical stability of the suspensory structures is disrupted and muscle forces and the weight of the arm pull the glenoid fragment distally and anteromedially. To prevent late deformity we recommend internal fixation of the fractured clavicle. Fractures of the scapula are high-energy injuries. Clavicle fractures are common, usually being caused by a fall on an outstretched hand or a blow to the tip of the shoulder. Conservative treatment usually produces good or excellent results in injuries of the clavicle or of the scapula, but this is not so when both bones are injured simultaneously and when there is >2cm displacement of the lateral fragment of the clavicle. Several methods of fixation for lateral end of clavicle have been described. We treated this unusual injury with Intercostal drain insertion and Steinmann pin Fixation for the left clavicle fracture as there was impingement on the parietal pleura.

The clinical effects of straight incision in the treatment of scapular neck and body fractures

Objective To evaluate the clinical effect of straight incision in the treatment of scapular neck and body fractures .Methods 62 cases with scapular neck and body fractures were randomly divided into the obser -vation group （30 cases） and control group （32 cases）.The control group was given the traditional Judet approach operation,the observation group was given the straight incision operation .The general situation of operation ,fracture healing time ,clinical efficacy and postoperative complications were observed .The improvement of joint function after operation was evaluated .Results The operation incision ,operation time and intraoperative blood loss of the observa-tion group were significantly better than those of the control group （t=9.599,9.506,21.297,P〈0.01）.The fracture healing time between two groups had no statistically significant difference （t=0.922,P=0.35）.The effective rate of fracture healing in the observation group was 93.3%,which was significantly higher than 71.9%of the control group （χ2 =4.885,P〈0.05）.The incidence rate of complication in observation group was 13.3%,which was lower than 37.5%in the control group（χ2 =4.723,P〈0.05）.The score of daily activities in observation group was better than the control group（t=3.761,P〈0.01）.Conclusion The straight incision operation is more minimally invasive in the treatment of scapular neck and body fractures compared with Judet approach ,and it has better prognosis . Key words: Straight incision; Judet approach; Shoulder fractures

Fractures of the scapular neck: diagnosis, classifications and treatment.

Fractures of the scapular, or glenoid, neck are strongly debated in the relevant literature. Analysis of the respective studies, however, revealed a considerable confusion in terms of definition, terminology and diagnosis. In addition, there are few studies, primarily case reviews, dealing in detail with these fractures. The aim of this article is to present detailed information about fractures of the scapular neck, based on the analysis of our own experience and of the published literature. Our group of 17 fractures of the scapular neck comprised 14 men and three women, with a mean age of 38years (range, 24-55). The authors diagnosed four fractures of the anatomical neck, nine fractures of the surgical neck and five trans-spinous fractures of the neck. Of these 17 scapular neck fractures, six fractures were treated non-operatively, and 11 fractures were operated on via the posterior Judet approach. The mean follow-up was 4.9years (range, 1-11). Fractures in all six non-operatively treated patients healed without complications in the anatomical position and with full function of the shoulder. In 11 operatively treated patients, all fractures of the scapula and clavicle healed within threemonths. In nine cases the function of the shoulder was subjectively and objectively assessed as normal, and in the remaining two cases as fair. The term "scapular, or glenoid, neck" covers three different types of fractures, i.e., fracture of the anatomical neck, fracture of the surgical neck and trans-spinous neck fracture. Fractures of the surgical neck are divided into stable, fractures with rotational instability and fully unstable fractures, depending on the integrity of the coracocacromial and coracoclavicular ligaments. Accurate diagnosis of fractures of the scapular neck requires 3D CT reconstructions. Undisplaced or minimally displaced fractures may be treated non-operatively, markedly displaced fractures constitute an indication for osteosynthesis via the Judet approach.

Surgical treatment of double disruption of the superior shoulder suspensory complex

Objective To investigate the procedures and effects of surgical treatment for double disruption of the superior shoulder suspensory complex (SSSC).Methods Twenty-nine cases of double disruption of SSSC treated from January 2007 to October 2011 were enrolled in the study.There were 19 males and 10 females,at a mean age of 36 years (range,25-49 years).Injury causes included traffic injury in 25 cases and fall from height in 4.An open reduction and internal fixation was performed in 18 cases of scapular neck fracture combined with clavicular fracture,2 cases of scapular neck fracture combined with acromion fracture,2 cases of distal clavicular fracture combined with acromion and glenoid cavity fracture; hook plate fixation and ligament repair were performed in 3 cases of complete dislocation of acromioclavicular joint combined with complete disruption of coracoclavicular ligament ; open reduction and internal fixation and ligament repair were performed in 3 cases of scapular neck fracture combined with acromioclavicular joint dislocation and 1 case of clavicular fracture combined with coracoclavicular ligament disruption.Results All cases were followed up for a mean period of 11.5 months (range,6-30 months).Anatomic reduction of fractures was achieved for all cases and mean healing time was 8.4 weeks (range,7-12 weeks).Mean Constant-Murley score was 91 points (range,72-100 points),which indicated excellent results in 13 cases,good in 11,fair in 5,with excellence rate of 83％.ConclusionBased on the complex anatomic structure of the double disruption of SSSC,surgical management should focus mainly on respective fixation of the double injuries,which leads to good stability and therapeutic outcome. Key words: Shoulder fractures ; Scapula; Clavicle ; Fracture fixation, internal