J Korean Orthop Assoc.  2020 Feb;55(1):46-53. 10.4055/jkoa.2020.55.1.46.

Clinical Results of Lateral-Posterior Internal Fixation for the Treatment of Scapular Body Fractures

Affiliations
  • 1Department of Orthopedic Surgery, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea. simba0415@catholic.ac.kr

Abstract

PURPOSE
Scapular body fractures have generally been treated with non-surgical methods. This study reports the clinical and radiological outcomes after lateral-posterior internal fixation for treating displaced scapular body fractures.
MATERIALS AND METHODS
From March 2007 to May 2017, out of 40 patients who underwent internal fixation for scapular fractures, 13 cases of lateral plate fixation of a scapular body fracture were reviewed retrospectively. Preoperative and postoperative displacement, angulation and glenopolar angle (GPA) were measured. The range of shoulder motion, visual analogue scale (VAS), and disabilities of the arm, shoulder, and hand (DASH), and Constant score were assessed at the last follow-up.
RESULTS
The mean follow-up period was 17.7 months (range, 6-45 months). The mean preoperative GPA was 23.3°±3.96° (range, 17.8°-28.1°) and the postoperative GPA was 31.1°±4.75° (range, 22.5°-40.1°). Injury to the suprascapular nerve, nonunion, fracture redisplacement, metallic failure, or infection did not occur. At the last follow-up, the mean range of motion was 150.5°±19.3° in forward flexion, 146.6°±2.34° in lateral abduction, 66.6°±19.1° in external rotation, and 61.6°±18.9° in internal rotation. The VAS, DASH, and Constant scores were 1.7±1.3, 6.2±2.4, and 86±7.9 points, respectively.
CONCLUSION
A scapular body fracture with severe displacement, angulation and marked decreased GPA can be stabilized by lateralposterior plate fixation using the appropriate surgical technique with good functional and radiological results.

Keyword

scapula; body fracture; lateral-posterior; plate fixation; clinical results

MeSH Terms

Arm
Follow-Up Studies
Hand
Humans
Range of Motion, Articular
Retrospective Studies
Scapula
Shoulder

Figure

  • Figure 1 Measurements of the radiographical parameters. (A) The glenopolar angle (GPA) was measured on a true anteroposterior radiograph of the shoulder. A line is drawn from the superior pole of the glenoid fossa to the inferior pole. And other line is drawn from the superior pole of the glenoid fossa down to the most inferior pole of the scapular body. The angle formed by these two lines represents the GPA (normal range, 30°–40°). (B) Displacement was measured on a trans-scapular Y view. The distance between the anterior or posterior cortex of the proximal and distal fragments represents the displacement. (C) Angulation was measured on a trans-scapular Y view. One line was drawn though the proximal fragment parallel to the cortex and the other line was drawn though the distal fragment. The angle formed by these two intersecting lines represents the angulation of the fracture site.

  • Figure 2 Surgical techniques. (A) Illustration of incision line for modified Judet approach. (B) Inter-nervous approach between infraspinatus and teres minor. (C) Five-hole plate fixation at lateral posterior aspect of scapula.

  • Figure 3 A Fifty-year-old female, fracture of the right scapular body with comminution of lateral border. (A) Plain and computed tomography image showed a comminuted fracture with 26.2° of glenopolar angle (GPA) and 37 mm displacement. (B) After fixation of the lateral border with a dynamic compression plate and wiring for the medial border, GPA changed to 31.8° without displacement and angulation. (C) Radiographs after the removal operation.

  • Figure 4 A 42-year-old male, fracture of the right scapula. (A) Preoperative images showed a comminuted body fracture with 22° in glenopolar angle (GPA) and 20 mm displacement. (B) GPA was reduced in the normal range (31.1°) after lateral dynamic compression plate fixation with 96 points of the Constant score and full range of shoulder motion.


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