Superior Shoulder Suspensory Complex Research Articles

Analysis of the curative effect and prognostic factors in patients with scapular fracture with surgical indications after conservative treatment: a case series and clinical outcomes.

The choice of treatment for scapular fractures is a topic worth discussing. The type of scapular fracture is often complex, and more and more scholars prefer surgical treatment to obtain better shoulder joint function. In addition, because of the rich blood supply and muscles of the scapula, some scholars believe that simple suspension can also achieve satisfactory clinical effects. The aim of this study was to investigate the curative effect and prognostic factors of patients with scapular fracture with indications for surgery after receiving conservative treatment. Patients with scapular fracture who did not receive surgical treatment from July 2016 to May 2021 were recruited from the orthopedic trauma database of Nanjing Gulou Hospital, and the data from patients with indications for surgery were screened out for a retrospective analysis. The data were obtained from the database of orthopaedic trauma patients in Nanjing Drum Tower Hospital. The relevant data were recorded during telephone and video follow-up visits. Linear regression was used to analyze the factors associated with disabilities of the arm, shoulder and hand (DASH) score after receiving conservative treatment. A total of 21 patients were included in the final statistical analysis. All patients were followed up for 31.0±20.3 (range, 6-63) months, aged 52.9±12.7 (range, 27-71) years. All fractures had clinical healing with a 100% recovery satisfaction rate. Outcome measures of efficacy [both DASH scores and visual analogue scale (VAS) scores], were correlated with whether the fracture involved the superior border of the scapular, were not associated with the following variables: age (P=0.18), Injury Severity Score (ISS) score (P=0.10), the glenopolar angle (GPA) value (P=0.76), superior shoulder suspensory complex (SSSC) injury (P=0.82), and glenoid fracture (P=0.84). The range of motion of the affected shoulder was significantly reduced compared to the healthy shoulder (P<0.01), but the range of forward flexion and elevation was not significantly different from that of the healthy shoulder (P>0.05). Patients with fractures not involving the superior border of the scapula had a much lower range of motion in the affected shoulder than in the healthy shoulder during abduction (P<0.05). The range of surgical indications for scapular fractures with scapular fractures involving the lower margin of the scapular can be appropriately narrowed. Some patients with scapular fracture who have surgical indications can regain satisfactory shoulder function after receiving conservative treatment.

Superior Shoulder Suspensory Complex Reconstruction For Acute And Chronic ACJ Dislocations Using Lars Artificial Ligament: Evaluating The Early Outcome Of A 3-Tunnel Technique

Superior Shoulder Suspensory Complex Reconstruction For Acute And Chronic ACJ Dislocations Using Lars Artificial Ligament: Evaluating The Early Outcome Of A 3-Tunnel Technique

Open Triple Disruptions of the Superior Shoulder Suspensory Complex: About a Rare and Controversial Injury

Open Triple Disruptions of the Superior Shoulder Suspensory Complex: About a Rare and Controversial Injury

Stability, Deformity and Fixation of the Floating Shoulder: A Cadaveric Biomechanical Study.

Floating shoulder injuries cause instability and deformity due to disruptions of the scapula, clavicle and superior shoulder suspensory complex (SSSC) ligaments. Resulting deformity of the glenopolar angle (GPA) has not previously been established, nor has the impact on stability and deformity when surgical fixation is performed. This study sought to quantify stability and deformity for multiple injury patterns, and the improvement to these parameters provided by clavicle and coracoclavicular (CC) ligament fixation. Fourteen cadaveric specimen upper extremities were used, which included the entire upper extremity, scapula, clavicle and cranial-most ribs. After being mounted upright, a scapular neck fracture was created, followed by either a midshaft clavicle fracture or sectioning of the acromioclavicular (AC) and coracoacromial (CA) ligaments. Subsequent sectioning of the other structure(s) followed by the CC ligaments was then performed. In all specimens the clavicle was then plated, followed by a CC ligament repair. At each step, a radiograph in the AP plane of the scapula was taken to measure GPA, and displacement of the glenoid fragment using radiopaque markers placed in the scapula. These radiographs were taken both unloaded and with a 100N applied medializing force. When evaluating deformity related to sectioning, the GPA was reduced when the CC ligaments were sectioned compared to an isolated scapula fracture (p=0.022) and compared to a combined scapula and clavicle fracture (p=0.037). For stability, displacement with a 100N force was significantly increased when the CC ligaments were sectioned compared to an isolated scapula fracture (p=0.027). In cases of an ipsilateral scapula neck and clavicle fracture with intact ligaments, fixation of the clavicle alone provided a statistically significant improvement in GPA (p=0.002); but not in reduction of displacement (p=0.061). In cases of an ipsilateral scapula neck and clavicle fracture with concomitant disruption of the CA, AC and CC ligaments, GPA was improved by clavicle fixation (p<0.001), and increasingly so by subsequent CC ligament repair (p<0.001). Displacement was also improved in these two states respectively (p<0.001, p=0.008). This biomechanical study confirmed the importance of the AC, CA and CC ligaments in conferring stability in SCCC injuries. Disruption of the CC ligaments created significant deformity of the GPA and instability with a medializing force. Clinical treatment should consider the integrity of these ligaments and their repair in conjunction with clavicle fixation, knowing that this combination should restore a biomechanical state equivalent to an isolated scapula fracture.

Triple Disruption of the Superior Shoulder Suspensory Complex - Review and Surgical Technique.

The shoulder girdle is composed of two arches, and these two arches are held together by the superior shoulder suspensory complex (SSSC), a ligamentous complex. Goss's 1993 description of the SSSC as a ring includes the glenoid, coracoid process, coracoclavicular ligaments, distal clavicle, acromioclavicular joint, and acromion. Goss also noted in a 1996 study that a rupture of the SSSC in two places can result in an unstable lesion. This case report presents an unusual association of fractures involving the coracoid process, acromion, and distal clavicle, which has rarely been reported in the literature. Indeed, a triple lesion of the SSSC is very uncommon and the treatment is still debated. Therefore, we propose a surgical technique which we believe to have provide good results. A 54-year-old Caucasian male patient presented with Neer I distal third fracture of the clavicle, a displaced fracture of the acromion, and a fracture of the coracoid process following a left shoulder trauma after an epileptic crisis. The patient underwent surgery and has been followed for 1 year with good clinical and functional outcomes. This case report highlights the complexity of lesions of the SSSC and the importance of determining proper surgical technique based on the type of lesion. It demonstrates that surgery combined with active rehabilitation can lead to good functional outcomes for patients with this type of injury. This report will be of interest to clinicians involved in the treatment of this type of lesion and should add a valuable treatment option for the treatment of triple disruption of the SSSC.

Surgical management of multiple superior shoulder suspensory complex disruptions involving at least a coracoid fracture and an acromioclavicular dislocation: A report of five cases

A combination of coracoid fracture and acromioclavicular dislocation is rare. Detecting further pathologies that could cause multiple superior shoulder suspensory complex disruptions is mandatory. Literature regarding these injuries and their management is lacking. We report our diagnostic and surgical strategies, and the postoperative outcomes of superior shoulder suspensory complex disruptions. We present five cases, treated from 2011 to 2016, who had >2 disruptions of the superior shoulder suspensory complex, involving at least a coracoid fracture and an acromioclavicular joint dislocation. Surgical reconstruction was performed in all cases. The patients were postoperatively followed up for a year. There were no intraoperative or postoperative complications, and bone union was achieved in all fractures. Furthermore, all patients returned to their pre-surgery activity level and jobs. Thus, we could demonstrate that in multiple superior shoulder suspensory complex disruptions involving a coracoid fracture and an acromioclavicular joint dislocation, surgical treatment leads to a good functional outcome.

Isolated fracture of the coracoid’s process base 9-years after a Latarjet procedure: A novel case report

Coracoid fractures (CF) are relatively uncommon injuries and in most cases are associated with other concomitant lesions to the superior shoulder suspensory complex (SSSC). As far to the authors’ knowledge, there are no reports of an isolated acute fracture of the base of the coracoid process, years after Latarjet procedure. The authors present the case of a 51-year-old male and non-professional cyclist, with a history of left shoulder Latarjet procedure 9-years ago, sustained a high energy trauma to the left anterior shoulder. Imaging studies revealed a non-displaced fracture to the base of the reminiscent of the coracoid’s process, without other associated injuries to the SSSC or to the coracoid’s graft. A conservative treatment was approached. 1-year after CF, the patient is asymptomatic with CT scan confirming healing of the fracture in an adequate position. Despite very rare, fracture of the reminiscent of coracoid process should always be ruled out after a direct high energy trauma to the anterior shoulder, in patients with previous Latarjet procedure.

A Comprehensive Radiologic Review of Shoulder Girdle Trauma.

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.

Quadruple Disruption of the Superior Shoulder Suspensory Complex: Case Report and Review of the Literature

Quadruple Disruption of the Superior Shoulder Suspensory Complex: Case Report and Review of the Literature

Floating Shoulder Review

Floating shoulders are a double disruption injury of the Superior Shoulder Suspensory Complex (SSSC) [1]. Traditionally, in a floating shoulder the neck of the scapula and the distal clavicle are fractured but the definition has evolved to include concurrent tears of the coracoacromial and acromioclavicular ligaments [2, 3]. This injury is very rare, with incidence having been defined as being roughly 0.1% [4, 5]. The majority of these injuries are often caused by a high energy trauma, usually motor vehicle crashes [6]. However, they may also be caused by other mechanisms, including fall from height, motorcycle accidents, bicycle accidents, and gunshot wounds [7].

Scapular Fractures at a Level 1 Trauma Center: A Cross-Sectional Study.

Purpose: Scapular fractures are uncommon injuries that account for up to 1% of all fractures and 5% of all shoulder girdle fractures. Moreover, most of the evidence on the treatment of scapular fractures stems from case series, with paucity of comparative studies. Despite the lack of standardized criteria for the operative treatment of scapular fractures, a set of suggested radiological parameters has been recently reported. The primary aim of this study was to compare the treatment implemented for scapular fractures in comparison with standard published criteria. The secondary aim was to investigate epidemiological parameters of scapular fractures at a level 1 trauma center.Methods: In this cross-sectional study of scapular fractures at a level 1 trauma center, data were collected between December 2012 and January 2016. Data of all scapular fractures that presented to our center were retrospectively collected through electronic medical records. Identified cases of scapular fractures were then evaluated whether surgical treatment was indicated in accordance with recent standard operative criteria. Percentages were used to express the number of cases that were operatively indicated according to the predefined criteria and the number of cases operatively treated at our institution.Results: A total of 52 patients met the inclusion criteria of having scapular fractures documented on radiography and Computed tomography (CT). The mean age of the patients was 38.5 years, with the majority being men (92.3%). The most common mechanism of injury was a fall from a considerable height in 26% of the cases. Of the included patients, 53.8% were polytraumatized, and the most frequent concomitant traumatic injury was rib fractures (26.9%). Only 33% of intra-articular glenoid fractures with significant displacement were treated operatively. Furthermore, non-operative treatment was undertaken in indicated extra-articular scapular body and neck fractures, acromion or coracoid process fractures, or superior shoulder suspensory complex double disruptions.Conclusion: A significant discrepancy was found between the treatments implemented at our institution and the current standard criteria for the operative treatment of scapular fractures. This study emphasizes the need to educate surgeons on scapular fractures and to treat such fractures in accordance with standard published criteria. Furthermore, scapular fractures that require surgery should be referred to a surgeon experienced in scapular fracture fixation.

Rare coracoid fractures presenting with superior shoulder suspensory complex injury: A case series.

Although coracoid fractures are rare fractures, their treatment is critical as they form the coracoacromial arch and superior shoulder suspensory complex (SSSC), which are important structures for shoulder biomechanics. In this case series, clinical, radiological, and demographic characteristics of three male patients who received treatment due to coracoid fracture presenting with traumatic injuries were discussed. The fractures were classified according to the Ogawa and Eyres classifications, and fracture fixation was achieved surgically with the cannulated screws. All patients had a right coracoid fracture. The Constant–Murley Score and the Disabilities of the Arm, Shoulder and Hand scores the patients in the final follow-up visit at 12 months were calculated. In conclusion, good clinical and functional outcomes can be achieved by anatomical reduction and fixation through surgery for displaced coracoid fractures presenting with multiple traumatic injuries located in multiple regions of the SSSC.

Double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle for treatment of floating shoulder injuries

To investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries. Between January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function. All incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly ( P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores ( P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%. Double internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.

Arthroscopic Management of a Coracoid Fracture Associated With Acromioclavicular Dislocation: Technical Note

Operative management of a coracoid process fracture is indicated in case of painful nonunion, displacement of more than 1 cm, or multiple disruptions of the superior shoulder suspensory complex. Several techniques have been described with open reduction of the fracture and internal fixation using cortical screws with or without additional fixation of the acromioclavicular joint. This Technical Note aims to introduce an alternative safe, minimally invasive method for arthroscopic fixation of a coracoid fracture with simultaneously reduction of the acromioclavicular joint. The described arthroscopic technique might be helpful for shoulder surgeons who want to fix the coracoid process while avoiding the disadvantages of an open approach.

Nonunion of the coracoid process: a systematic review.

Although the coracoid process seems to play an important anatomical role, there are few reports concerning fracture nonunion of the coracoid process (CN) and its disorders. Therefore, there is no widely accepted standard for the treatment of CN. PubMed and Scopus were searched using "scapular fracture" and "coracoid fracture" as search terms. The inclusion criteria were English full-text articles concerning coracoid fracture, and articles that described patient characteristics and presented appropriate images. The exclusion criteria were descriptive cases, and cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using Ogawa's functional classification, with Eyres' anatomical classification used as a supplement when necessary. Twenty-nine patients (26 men, 3 women) with 30 CN were identified. Nine CN had a predisposing factor such as seizure disorder and renal osteodystrophy. The fracture types were 12 Ogawa type I and 18 type II. Concurrent shoulder girdle injuries at the time of initial trauma/accident were varied. There were six cases of double disruption and two of triple disruption of the superior shoulder suspensory complex (SSSC), all of which had Ogawa type I fracture. Only six CN were isolated. The most frequent cause of CN was oversight by the previous physician (n = 11), followed by conservative treatment (n = 7). Although 12 patients with 13 CN had symptoms attributable to CN, most of these symptoms were insignificant. Although the acromioclavicular dislocation or CN persisted in eight patients, these residual abnormalities did not significantly affect the outcomes. Physicians treating CN should recognize that CN itself is frequently asymptomatic, and a satisfactory outcome is achieved solely by treating the concurrent injuries, even if CN remains. When CN is suspected to produce symptoms, the physician must then determine the mechanism by which the symptoms are produced, and select a treatment strategy. V.

Short and medium term outcome of surgical treatment of the floating shoulder

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Floating shoulder are rare injuries just because of high velocity of trauma and road traffic accidents. The aim of this study was to evaluate the functional outcome of surgically treated clavicle, glenoid and both bone injuries.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted in the department of orthopaedics, Sir. T. Hospital, Bhavnagar from October 2009 to November 2013. Out of 25 patients all turned up for follow up. Functional and clinical assessments done with range of movements in surgically treated fractures of clavicle, glenoid and both bone group.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All bone fractures are united in all the patients. The mean follow up period was 30 months. The mean functional result was assessed using Rowe score to assesses the function, pain, stability and motion. All the cases showed excellent to fair results after follow up period.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Surgical treatment for double disruption of the superior shoulder suspensory complex, which is inherently an unstable and rare injury, is a good option, allowing early rehabilitation and improving the functional outcome.&lt;/p&gt;

Treatment of coracoid process fractures: a systematic review.

The coracoid process is a small hook-shaped feature on the scapula and a key structure of the superior shoulder suspensory complex (SSSC). Fractures of the coracoid are rare. Therefore, no consensus exists regarding treatment of coracoid process fractures. Systematically review indications, outcomes and complications of traumatic coracoid process fractures in adults, and to provide a treatment algorithm. A systematic review was performed to identify all relevant studies on the treatment of coracoid process fractures. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS). Eight case series, with a total of 110 coracoid process fractures, were included. All studies were of moderate methodological quality. Of the fractures, 78% were Ogawa type I fractures, 13% Ogawa type II and 9% were unclassified. Conservative treatment showed good results in most Ogawa type II fractures and type I fractures without associated disruptions of the SSSC. Most Ogawa type I fractures with associated disruptions of the SSSC received surgical treatment showing good results. Based on moderate quality studies, surgical treatment may be considered in Ogawa type I fractures with multiple disruptions of the SSSC. A conservative treatment seems sufficient in other fracture types.

Fractures of the Coracoid Process: Evaluation, Management, and Outcomes.

Fractures of the coracoid process are relatively rare, and current management guidelines remain unclear. Most coracoid fractures occur in conjunction with other shoulder injuries, including dislocations and fractures. Identifying coracoid fractures can be difficult because most fractures are nondisplaced and can be missed on radiographs or may be masked by other injuries. Management is largely guided by fracture location and displacement. Conservative treatment is preferred for fractures that are minimally displaced, whereas indications for surgical fixation include fractures that are displaced (>1 cm), have progressed to a painful nonunion, or are associated with the disruption of the superior shoulder suspensory complex. Although conservative treatment has been historically favored, satisfactory outcomes have been reported for both surgical and nonsurgical treatment. We provide a comprehensive review of diagnosis and management strategies for coracoid fractures.

Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture

To investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture. Between January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC. All incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%. Open reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.

Floating Shoulder: Myths and Reality.

* “Floating shoulder” may be considered to be an unstable displaced fracture of the surgical or anatomical neck of the scapula with or without a clavicular fracture.* In cases of surgical neck fractures, there must occur an associated rupture of the coracoclavicular and coracoacromial ligaments or a fracture of their osseous equivalents (acromion and extra-articular or intra-articular coracoid base).* Injury to the superior shoulder suspensory complex without a fracture of the anatomical or surgical neck does not result in floating shoulder. If isolated, these superior shoulder suspensory complex lesions are mostly stable, and their displacement is minimal.* Radiographs are inadequate to determine the exact fracture pattern for fractures of the surgical neck and body of the scapula. Therefore, examination should include 3-dimensional computed tomographic reconstructions, in standardized views, with subtraction of the surrounding bones.* Unstable displaced fractures of the surgical or anatomical neck of the scapula should undergo a surgical procedure via the Judet approach.