On-line version ISSN 2309-8309
SA orthop. j. vol.7 n.3 Pretoria Jul./Sep. 2008
HR HobbsI; BR GarrettII; P SanchezIII; SJL RocheIV; BC VrettosV
IMBChB(UCT). Registrar, Department of Orthopaedic Surgery, University of Cape Town
IIMBChB(UCT). Registrar, Department of Orthopaedic Surgery, University of Cape Town
IIIMBChB(Wits), FCS(SA)Orth. Private Practice, East London
IVMBChB(UCT), FCS(SA)Orth. Consultant, Shoulder and Elbow Unit, Department of Orthopaedics, University of Cape Town
VMBChB(Zim), FRCS(Eng), FCS(SA)Orth, MMed(Orth)(UCT). Cape Town Centre for Bone and Joint Surgery, Vincent Pallotti Hospital
Scapular fractures requiring surgery are relatively rare injuries. This retrospective review looks at the outcome of open reduction and internal fixation of these fractures and the surgical exposures necessary for their fixation.
All surgically treated scapular fractures from January 2000 to December 2006, with the exception of Ideberg type Ia (anterior rim) fractures of less than 25% with an associated dislocation, had their clinical notes and radiology reviewed. The surgical approach was analysed with regard to the fracture classification and exposure. Reduction, union and failure of fixation were assessed. Outcomes were determined with respect to pain and range of movement.
At an average follow-up of 9 months (range 6 to 72 months), all of the fractures had united. Twenty out of the 25 patients were pain-free (80%) and the rest only had mild pain. Twenty-two patients (88%) had a good or functional range of movement. Adequate reduction was obtained in all but one fracture.
A good outcome can be expected in over 80% of scapular fractures requiring surgical fixation. Union is predictable and the complication rate is low. Most of the fractures can be addressed by employing teres minor/infra-spinatus intermuscular planes or subscapularis muscle splits without rotator cuff tenotomies.
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1. Goss TP. Scapular fractures and dislocations: diagnosis and treatment. J Am Acad Orthop Surg 1995;3:22-33. [ Links ]
2. Koval KJ, Zuckerman JD. Scapula. In: Handbook of Fractures (2nd edition). Philadelphia: Lippincott Williams & Wilkins; 2002: 75-9. [ Links ]
3. Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapular fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma 2006;20(3):230-3. [ Links ]
4. Kavanagh BF, Bradway JK, Cofield RH. Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa. J Bone Joint Surg Am 1993;75:479-84. [ Links ]
5. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orth Relat Res 1998 Feb;347:122-30. [ Links ]
6. Schandelmaier P, Blauth M, Schneider C, Krettek C. Fractures of the glenoid treated by operation. A 5- to 23-year follow-up of 22 cases. J Bone Joint Surg Br 2002 Mar;84(2):173-7. [ Links ]
7. Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures: incidence and classification of 338 fractures. Acta Orthop Scand 1995; 66(5):391-4. [ Links ]
8. Goss TP. Fractures of the glenoid cavity. J Bone Joint Surg Am 1992;74:299-305. [ Links ]
9. Boyer MI, Galatz LM, Borrelli J, Axelrod TS, Ricci WM. Intra-articular fractures of the upper extremity: new concepts in surgical treatment. AAOS Instr Course Lect 2003;52:591-605. [ Links ]
10. Dee R, Hurst LC, Gruber MA, Kottmeier SA. traumatic injuries of the shoulder and shoulder girdle. In: Principles of Orthopaedic Practice (2nd Ed). McGraw- Hill; 1997:398-400. [ Links ]
11. Miller ME, Ada JR. Fractures of the scapula, clavicle and glenoid. In: Skeletal Trauma: Fractures, Dislocations, Ligamentous injuries. Philadelphia: Saunders; 1992:1291-310. [ Links ]
12. Ada JR, Miller ME. Scapular fractures: an analysis of 113 cases. Clin Orthop 1991;269:174-80. [ Links ]
Dr SJL Roche
Fax: 027 21 532-2821
Tel: 027 21 404-5108
This article was submitted to an ethical committee for approval. The content of this article is the sole work of the authors. No benefits of any form have been derived from any commercial party related directly or indirectly to the subject of this article.