Study of treatment of scapular fractures with associated clavicle fractures

To explore the treatment methods for scapular fractures associated with clavicle fractures.Methods Of 23 cases with scapular fractures associated with clavicle fractures,13 treated conservatively took the function exercise of shoulder joint after two months and 10 treated with open reduction and plate fixation reconstruction began the function exercise of shoulder joint four weeks after operation.The follow up averaged 12 months.Results All patients were healed up.18 cases were followed up,of them 8 cases were treated surgically,10 cases,conservatively.Of eight cases treated surgically,seven got excellent functional recovery of the shoulder joint and one satisfactory.In the meantime,of 10 cases treated conservatively,the recovery of shoulder joint was excellent in six,good in three and poor in one.Conclusion As for scapular fractures with associated clavicle fractures,open reduction and plate fixation reconstruction is a good treatment method for it can keep the stability and the balance of shoulder joint and is helpful for early functional exercise and recovery of the shoulder joint.7 refs,5 figs.

Fracture of the scapular neck combined with rotator cuff tear:A case report

BACKGROUND Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of allfractures, and scapular neck fractures are extremely rare, comprisingapproximately 7%-25% of all scapular fractures. Scapular neck fractures are oftenstudied as case reports mostly accompanied by other injuries, thus leading toconfusion. All previous cases of scapular neck fractures are not associated withrotator cuff injuries.CASE SUMMARY A 62-year-old man was admitted to our emergency department 6 h after his rightshoulder and back were impacted by heavy objects. The patient presented chesttightness and shortness of breath. Chest computed tomography (CT) showedpneumohemothorax, multiple rib fractures, and right scapula fractures. ThreedimensionalCT reconstruction of the right shoulder joint showed a trans-spinousscapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injurywas suspected because the patient had a glenohumeral joint dislocation and wasthen confirmed by shoulder magnetic resonance imaging. A staged surgery wasperformed, including open reduction and internal fixation of the right scapulafracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mofollow-up, the fracture line was blurred and the shoulder joint function was good.CONCLUSION Fracture of the scapular neck combined with rotator cuff tear is rare and therotator cuff injury should not be ignored in clinical work. Stable internal fixationcombined with secondary arthroscopic repair of rotator cuff tear can achieve goodresults.

The evaluation of reverse shoulder lateralization on deltoid forces and scapular fracture risk:A computational study

Reverse shoulder arthroplasty(RSA)can treat severe rotator cuff deficiency,but its medialized design of the shoulder's center of rotation(CoR)has been associated with scapular notching.Although lateralization of CoR provides a larger impingement-free range of motion,the changes in component positioning alter the biomechanics and may cause unforeseen complications.This work quantified the muscle forces and predicted the scapula fracture risk by coupling dynamic simulation analysis with finite element modeling.To identify bone failure patterns,the results were analyzed using three common failure measures.A parametric study showed greater lateralization produced higher strain/stress concentrations in the scapular spine(Levy Region Type II),with approximately a 10%increase for the 12 mm lateralized scenario,compared to a neutral configuration.Significant differences in fracture risk patterns were found between the maximum principal stress/strain results and the von Mises stress results.The lateralized configurations could increase the muscle and joint reaction forces during abduction and induce scapular fracture.Studying the effects of RSA lateralization on scapular fracture risk can help guide the continued optimization of RSA performance and surgical techniques.The findings of relationships between the loading style and bone failure measures can provide valuable insight into the investigation of bone failure criteria.

Ipsilateral fractures of the acromion and coracoid processes of the scapula

A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic,due to the acromion's anatomical position and shape,as well as the strong ligaments and muscles that are attached to it.These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint,leading to severe pain and a grossly restricted range of motion.Several acromial classifications were reported,but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature.We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture.The closest to this is Kuhn's type III classification.A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident.The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications.He was asymptomatic postoperatively and regained full range of motion after 4 months.