Korean J Sports Med.  2019 Dec;37(4):149-154. 10.5763/kjsm.2019.37.4.149.

Scapular Dyskinesis Assessment with Low Dose Three-Dimensional Wing Computer Tomography after Anatomical Union of Clavicle Fracture

• Kim YS
• Kim JG
• Hwang JT
• Shim JC
• Jang SH

• KMID: 2466804
• DOI: http://doi.org/10.5763/kjsm.2019.37.4.149

Abstract

PURPOSE
Malunions after clavicle fractures are generally considered to cause scapular dyskinesis. This study aims to verify the incidence of scapular dyskinesis following anatomically reduced clavicle fracture and to verify the usefulness of low-dose three-dimensional (3D) scapular wing computed tomography (3D-scapula wing-CT) analysis.
METHODS
Twenty-four patients with mid-clavicle fracture and four patients with distal clavicle fracture were recruited. After anatomical reduction and bony union, scapular dyskinesis was assessed by history taking and physical examination by two orthopedic doctors. The mean follow-up period for the assessment was 14.3±10.1 months. Low-dose 3D-scapular wing-CT analysis in prone position was performed with calculated effective dose 2.35 mSv, which means approximately 25% dose of conventional setting. Four observers evaluated five angles (upward rotation, internal rotation, anterior tilting, superior translation, protraction) from 3D-reconstructed images on both shoulders of a patient. Authors analyzed the results between injured to normal shoulder.
RESULTS
Scapular dyskinesis or significant shortening of injured clavicle (mean clavicle length difference, − 1.77±6.36 mm) were not observed among the included 28 subjects. The difference values of the five angles between the fractured side and normal side showed no statistical significance (upward rotation: 1.51, p=0.13; superior translation: 0.89, p=0.327; anterior tilting: 1.7, p=0.096; protraction: 0.83, p=0.374; internal rotation: 0.98, p=0.406). As the interclass correlation coefficients of four observers was 0.988 (p=0.00), images from low-dose 3D-wing-CT are clear enough to assess scapular dyskinesis (interclass correlation coefficient, 0.996; p=0.00).
CONCLUSION
It is important to make anatomical reduction and length restoration of clavicle fracture for preventing scapular dyskinesis. Low-dose 3D-scapular wing-CT is an effective tool for assessing scapular dyskinesis, which provides images of sufficient quality with little increase in morbidity from radiation hazard.

Keyword

Clavicle fracture; Radiation dosage; Scapular dyskinesis; Three-dimensional computed tomography

MeSH Terms

Clavicle*
Follow-Up Studies
Humans
Incidence
Orthopedics
Physical Examination
Prone Position
Radiation Dosage
Shoulder

Figure

• 

  Fig. 1 Low dose three-dimensional wing computed tomography images in prone position. (A) Upward rotation (UR) angle: the angle between the extension of the line from the acromioclavicular (AC) joint to root of scapular spine (RSS) and the vertebral axis (C7–T7) on a posterior-coronal view. (B) Internal rotation (IR) angle: the angle between the line joining the 2 AC joints and the line from the corresponding AC joint to RSS on a superior-axial view. (C) Anterior tilting (AT) angle: the angle between the line from the inferomedial angle of scapula parallel to the medial border of scapula and the line joining the anterior tips of C7 and T7 vertebrae on a lateral-sagittal view. (D) Superior translation (ST) angle: the angle between the line from the AC joint to midpoint of the spinous process of the C7 vertebra and the vertebral axis (C7–T7) on a posterior-coronal view. (E) Protraction (PRO) angle: the angle between the line parallel to the vertebral axis (C7–T7) and the line from the corresponding AC joint to the center of the C7 vertebral body on a superior-axial view.

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