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PubMed1994

[Mandibular reconstruction using a vascularized osteocutaneous scapular flap].

Composite tissue defect of the mandible following the surgical resection of head and neck neoplasma or osteoradionecrosis causes functional and cosmetic disorders. Mandibular reconstruction is, therefore, necessary to obtain satisfactory results. The introduction of microvascular surgery has made it possible to transfer various types of vascularized bone grafts and this technique is considered one of the most reliable procedures for mandibular reconstruction. Recently it has been reported that an osteocutaneous scapular flap is useful for mandibular reconstruction. We have performed, over the last 2.5 years, 13 mandibular reconstructions using a vascularized osteocutaneous scapular free flap, and successful results have been achieved. The features of this flap are as follows: 1) it provides a consistent blood supply to the bone and the skin and has a constant vascular pedicle; 2) since the skin island and bone flap have separate pedicles, three-dimensional reconstructions are facilitated; 3) if needed, two skin flaps can be elevated; 4) the skin island is not so bulky; 5) the lateral border of the scapula provides highly vascularized bone of thick cortical density and osteotomies are safely performed; 6) using an angular branch based on thracodorsal artery, a bi-pedicled scapula bone can be raised and two completely vascularized bone segments can be transferred with a single pedicle. Thus, a vascularized osteocutaneous scapular flap has proven very useful for complex mandibular reconstructions.

Adult↗
PubMed1999

Low-energy scapular body fracture: a case report.

Scapula fractures are relatively rare and most often the result of high-energy trauma. However, they should always be included in a physician's differential diagnosis when a patient has a complaint of shoulder pain after trauma or violent muscular contraction about the shoulder. Because the vast majority are the result of a high-energy mechanism of injury, the physician should, as always, completely evaluate the patient for associated injuries. Most scapula fractures can be diagnosed on physical examination with localized tenderness, swelling, and hematoma formation over the fracture site. Radiographic confirmation and evaluation is routinely made using the three-view trauma series of the shoulder; additional views are rarely indicated. Treatment, consisting of a sling or sling and swath for comfort, mild narcotic medication, and early range-of-motion exercises virtually always leads to union and good glenohumeral function. Operative treatment is rarely indicated. A case of an low-energy isolated scapular body fracture sustained by a 41-year-old man is presented.

Adult↗
PubMed1999

Arthroscopic Bankart repair of anterior detachments of the glenoid labrum. A prospective study.

BACKGROUND: The purpose of this study was to evaluate the results of an arthroscopic transglenoid suture-stabilization procedure in athletically active patients who had recurrent, unilateral, unidirectional anterior dislocations of the shoulder and an isolated anterior detachment of the glenoid labrum. METHODS: Forty-one patients who had unilateral, unidirectional anterior dislocations of the shoulder and an isolated anterior detachment of the glenoid labrum were managed with arthroscopic repair. All patients were athletic, and seventeen of the male patients were football players. No patient had inferior or posterior laxity or a posterior detachment. The sutures were anchored to the posterior aspect of the scapula, and the knots were tied anteriorly to secure the detached region of the labrum and the inferior glenohumeral ligament to the anterior aspect of the scapula. The mean duration of follow-up was fifty-two months (range, twenty-five months to seven years). The patients were evaluated annually with a physical examination, radiographs, isokinetic strength-testing, the modified shoulder-rating scale of Rowe and Zarins, and the scoring system of the American Shoulder and Elbow Surgeons. RESULTS: Forty (98 percent) of the forty-one athletes returned to their preoperative sport postoperatively. Thirty-nine patients (95 percent) had no additional dislocations or subluxations, and two (5 percent), both of whom were football players, had a single episode of subluxation. Thirty-seven patients (90 percent) had a score of at least 80 points on the scale of Rowe and Zarins, and thirty-four (83 percent) had a score of at least 90 points. Thirty-nine patients (95 percent) had a score of at least 80 points on the scale of the American Shoulder and Elbow Surgeons, and twenty-five (61 percent) had a score of at least 90 points. Lower scores were associated with loose bodies seen on arthroscopy (p = 0.001), osseous lesions seen on postoperative radiographs (p = 0.036), and subluxation (p = 0.000). Twenty-two shoulders (54 percent) had a full range of motion in all planes, and eighteen (44 percent) had no strength deficit in any position on isokinetic testing. With the numbers available for study, no significant association was found between the presence of a Hill-Sachs or an osseous Bankart lesion on preoperative radiographs and the overall score on the scale of Rowe and Zarins or the scale of the American Shoulder and Elbow Surgeons; however, there was a significant association between the range of motion and an osseous Bankart lesion on preoperative radiographs (p = 0.002) and between decreased strength on isokinetic testing and a Hill-Sachs lesion on preoperative radiographs and an osseous lesion on postoperative radiographs (p = 0.022). There also was a significant association between a decreased range of motion (p < 0.002) and decreased strength (p = 0.014) and the arthroscopic finding of loose bodies. Muscle strength also was affected by arm dominance and the number of preoperative dislocations. CONCLUSIONS: Arthroscopic transglenoid repair of isolated anterior labral detachments restored stability of the shoulder and led to a favorable outcome in thirty-nine (95 percent) of the forty-one athletes. Only the two football players who had postoperative subluxation had a score of less than 80 points according to the scale of the American Shoulder and Elbow Surgeons.

Adult↗
PubMed1999

Long thoracic nerve injury.

Injury to the long thoracic nerve causing paralysis or weakness of the serratus anterior muscle can be disabling. Patients with serratus palsy may present with pain, weakness, limitation of shoulder elevation, and scapular winging with medial translation of the scapula, rotation of the inferior angle toward the midline, and prominence of the vertebral border. Long thoracic nerve dysfunction may result from trauma or may occur without injury. Fortunately, most patients experience a return of serratus anterior function with conservative treatment, but recovery may take as many as 2 years. Bracing often is tolerated poorly. Patients with severe symptoms in whom 12 months of conservative treatment has failed may benefit from surgical reconstruction. Although many surgical procedures have been described, the current preferred treatment is transfer of the sternal head of the pectoralis major tendon to the inferior angle of the scapula reinforced with fascia or tendon autograft. Many series have shown good to excellent results, with consistent improvement in function, elimination of winging, and reduction of pain.

Humans↗
PubMed2000

Traumatic scapulothoracic dissociation.

Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. The diagnosis is based on clinical and radiographic findings of forequarter disruption. These include massive soft tissue swelling of the shoulder, displacement of the scapula and neurovascular injuries (brachial plexus, subclavian artery and osseous-ligamentous injuries). The mechanism of injury appears to be the delivery of severe rotational force sheering the shoulder girdle from its chest wall attachments around the scapula, shoulder joint and at the clavicle. Early recognition of the entity and aggressive treatment are crucial. Outcome is not dependent on management of the arterial injury, but rather on the severity of the neurological deficit.

Accidents, Traffic↗
PubMed2001

Latrogenic injury to the longthoracic nerve: an underestimated cause of morbidity after cardiac surgery.

After heart surgery, complications affecting the brachial plexus have been reported in 2% to 38% of cases. The long thoracic nerve is vulnerable to damage at various levels, due to its long and superficial course. This nerve supplies the serratus anterior muscle, which has an important role in the abduction and elevation of the superior limb; paralysis of the serratus anterior causes "winged scapula," a condition in which the arm cannot be lifted higher than 90 degrees from the side. Unfortunately the long thoracic nerve can be damaged by a wide variety of traumatic and nontraumatic occurrences, ranging from viral or nonviral disease to improper surgical technique, to the position of the patient during transfer to a hospital bed. Our patient, a 62-year-old man with triple-vessel disease, underwent myocardial revascularization in which right and left internal thoracic arteries and the left radial artery were grafted to the right coronary, descending anterior, and obtuse marginal arteries, respectively. Despite strong recovery and an apparently good postoperative course, the patient sued for damages due to subsequent winging of the left scapula. In this instance, the legal case has less to do with the cause of the lesion (which remains unclear) than with failure to adequately inform the patient of possible complications at the expense of the nervous system. The lesson is that each patient must receive detailed written and oral explanation of the potential benefits and all conceivable risks of a procedure.

Coronary Artery Bypass↗
PubMed1979

Scapular correlates of muscle morphology in Papio cynocephalus.

The scapula responds to the compressive states of its surrounding matrix produced by muscle functioning and weight bearing in the upper extremity with discernible structural correlates. These structural correlates can be utilized to infer locomotor behavior. After dissection and drying, the weights of several muscles of the shoulder region of 11 adult female baboons (Papio cynocephalus) were statistically compared to various dimensions of the bony scapula. A significant correlation was obtained between the weights of the individual compressive muscles, the combined weights of the compressive muscles and a scapular dimension of width. A nonsignificant correlation between these muscles and a sscapular dimension of length was also found. The results of this study were compared to those of a previous study of the scapular musculature in Macaca and opposing conclusions were obtained. The advisability of lumping macaques and baboons into a single gross locomotor category is rejected.

Animals↗
PubMedDate not supplied

[Technical quality control of chest x-rays for the health surveillance of workers exposed to the risk of pneumoconiosis: proposal for a qualitative screening method].

BACKGROUND: The necessity of a qualitative screening has arisen from the fact that good technical quality is of fundamental importance for evaluating initial pneumoconiosis, for reducing inter- and intra-reader variability, for effective secondary prevention and for forensic medicine purposes. OBJECTIVES: The authors report experience in use of a method to evaluate the quality of chest radiographs performed in health surveillance programs for workers at risk for development of pneumoconiosis. METHODS: 747 postero-anterior chest radiographs concerning employees of 21 ceramic factories in the Province of Viterbo were examined. A standardized pattern was created for this evaluation. The pattern considers the main factors that can influence the quality of chest radiographs and assigns points for each of them. That factors are: 1) reproduced image of the lung's vascular structure, chiefly in the peripheral portions; 2) reproduced image of heart border, aorta, diaphragm; 3) deep inspiration; 4) symmetric image of the chest; 5) position of the scapulae; 6) visualization of the costal-phrenic angles; 7) technical impairments. RESULTS: The application of the method revealed that half of the chest radiographs examined had poor image quality for a suitable reading, in conformity with the ILO 1980 guidelines. The critical points are poor visualization of the lung's vascular structure due to overexposure or underexposure, technical impairments, non-correct scapulae position. CONCLUSIONS: The authors believe that the suggested method can be a useful instrument for self-testing the quality of chest radiographs performed in radiology centers and for the National Health Service to test the quality of chest radiographs performed in health surveillance programs.

Adult↗
PubMed2004

The floating shoulder.

Ipsilateral fracture of the clavicle and scapula is considered to be a relatively rare injury. It is perceived as an unstable injury and is at times called floating shoulder. Understanding of the role played by the bony and ligament stability is important to identify true floating shoulder injury and to offer an appropriate treatment. Both conservative and surgical treatment modalities are described in the literature. Recent literature has shown the important role played by the ligaments in providing stability in ipsilateral fracture of the clavicle and scapula. In a true floating shoulder injury, it seems important to stabilise the injury by fixation of the scapular fracture. This article reviews the literature to identify the injury pattern of true floating shoulder and to look at the current evidence for the treatment of such an injury.

Clavicle↗
PubMed2005

Scapulothoracic arthrodesis: indications, technique, and results.

UNLABELLED: Twenty-two patients (24 shoulders) had a scapulothoracic arthrodesis for various clinical disorders including facioscapulohumeral muscular dystrophy, scapular winging from serratus anterior palsy, painful scapular crepitation, and cleidocranial dysostosis. All patients were extremely disabled with pain and loss of function because of their symptomatic scapular winging, and many of the patients had multiple previous procedures on their shoulders before the scapulothoracic arthrodesis. The surgical indication was stabilization of painful scapulothoracic articulation to provide pain relief and allow functional use of the involved arm for activities of daily living. The surgical technique involved use of a semitubular plate and wire construct along the medial border of the scapula with the use of autograft (iliac crest) or allograft bone or both between the scapula and the rib cage. Patients were immobilized postoperatively for 12 weeks. Complications occurred in more than (1/2) of the patients and included pulmonary complications, hardware failure, pseudarthrosis, and persistent pain. Postoperatively, 20 of 22 (91%) patients thought that the pain in their shoulder complex was improved and were satisfied with their functional outcome. Scapulothoracic arthrodesis can improve function and reduce pain in the shoulder complex in patients with debilitating complex scapulothoracic dysfunction. However, the high incidence of complications with this procedure is a concern. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Surgical treatment of sprengel's deformity: a modified Green procedure.

Twelve cases of Sprengel's deformity were treated surgically by a modification of Green's procedure. After clavicular osteotomy, all muscular attachments to the scapula were freed; an omovertebral band if present was cut and the scapula was rotated and moved caudal to a more normal position, to be sutured into a pocket of the latissimus dorsi. The patients included 10 female and 2 male patients (age range at the time of operation: 3 to 9 years; mean: 5.2 years). The deformity involved the left shoulder in 8 patients, the right shoulder in 4. All patients were followed for an average of 2 years (range: 6 months to 4.5 years). The range of flexion improved from an average of 95 degrees to 105 degrees and the range of abduction from an average of 81 degrees to 97 degrees. Cosmesis was improved in all 12 patients but three patients had an unsightly surgical scar. Surgical treatment by a modified Green procedure for patients with Sprengel's deformity is indicated when the patient and family want cosmetic or functional improvement.

Child↗
PubMed2006

Aggressive scapular chondroblastoma with secondary metastasis--a case report and review of literature.

Chondroblastoma is a benign bone tumor, accounting for approximately one percent of all benign bone tumors. It mostly occurs in typical locations such as long bones. Malignant transformation including metastasis has been described in only a few cases. Therefore, we report a unique case of chondroblastoma with tumor manifestation in the 7th decade of life, location of the tumor in the scapula and occurrence of metastasis in the soft tissue of the mandible branch. Due to aggravation of the clinical course, a scapula en bloc resection was performed. The differential diagnosis is discussed and the current literature concerning malignant transformation of chondroblastoma is reviewed.

Aged↗
PubMed2006

[Applicational study of 3D reconstruction with spiral computed tomography in evaluation of anatomical complicated bones fracture].

OBJECTIVE: To investigate forensic diagnosis application of three-dimentional reconstruction with spiral computed tomography in fracture of anatomical complicated bones. METHODS: Selected eleven patients of bone fracture who were examined with SCT 3D and conventional X-ray examination. The location, number and characteristics were observed and analyzed. RESULTS: In all of eleven patients with bone fractures, X-ray examination could detect thirty-four rib fracture, one scapula fracture, two nasal fracture, one metacarpal bone incomplete fracture and one left tibia-fibula fracture, one pubis fracture. While there were forty-seven rib fracture, one scapula smash fracture, one nasal fracture with obvious displacement and eliminate one misplace, one left tibia-fibula obsolete fracture and one sacroiliac joint dislocation, one No 5 lumbar vertebrae pedicle of vertebrae arch fracture. Combining 3D reconstruction images, coronary and sagittal reconstruction images could show clearly the fracture line, location of fracture, number of fracture, displacement and recovery. CONCLUSION: 3D reconstruction technique of SCT is a very useful examination method in the objective forensic diagnosis of anatomical complicated bones fracture, it excels the routine X-ray examination.

Adult↗
PubMed2006

Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited.

Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.

Adolescent↗
PubMed1991

Scapular allografts. A report of two cases.

Some malignant tumors of the scapula can be adequately treated by limb-sparing, partial, or total scapulectomy. However, resection of the glenoid portion of the scapula and total scapulectomy result in an unsightly shoulder. In an attempt to minimize the functional impairment and restore stability and cosmesis, scapular glenoid allografts offer a reasonably good biologic replacement. This report describes the cases of a 45-year-old woman and a 32-year-old man in whom massive osteoarticular allografts were used. In one patient, good stability, cosmesis, and function were restored after resection of the glenoid portion. In the other patient, shoulder stability, cosmesis, and limited function were restored after total scapulectomy. No reports of scapular allografts seem to have been previously published in the literature.

Adult↗
PubMedDate not supplied

A simple method of scapular retraction for posterolateral thoracotomy.

A simple method of scapular retraction for posterolateral thoracotomy is presented. This technique allows for retraction and stabilisation of the scapula and prevents it from protruding over the intercostal space chosen for entry into the chest cavity. It also facilitates insertion of the chest retractor and spreading of the intercostal space since reduced tension is now exerted on the rib cage by the retracted scapula and muscle layers.

Humans↗
PubMed1990

Damage of the long thoracic and dorsal scapular nerve after traumatic shoulder dislocation: case report and review of the literature.

A judo injury resulted in an anterior shoulder dislocation with a concomitant lesion of the long thoracic and the dorsal scapula nerve. This injury led to loss of function and extreme instability of the shoulder. Stabilization of the glenohumeral joint was successfully accomplished by surgery. The athlete declined further operative approaches to stabilize the scapula. The patient was able to return to the former level of athletic activity.

Adult↗
PubMed1990

[Fracture of the coracoid process: its classification and pathomechanism].

Twenty-eight cases of fractures of the coracoid process were assessed regarding general characteristics, causes of injury, regions of contused wound, fracture types and complications. From the results of the assessment, the fractures were roughly divided into five types: type I; apical, type II; middle, type III; basal, type IV; intraarticular (including upper 1/3-1/4 of the glenoid cavity), and type V; others. Subtypes A and B were present in type III and IV. From the specifics of the contusions and complicated osseous-articular injuries around the shoulder, the mechanisms of injury in each type may be suggests as follows: type I and II; tractive force of attached muscular tendons, type III and IV; shearing force acting between the scapula shifting inward due to blow from the lateral aspect of the shoulder and the clavicle countering this movement, and type V; unspecified. The main cause of fractures of the superior scapular margin was considered to be the tractive force of the superior transverse scapular ligament, because almost all cases of subtype A were complicated with them. For the benefit of the clinical use, they should be classified into two groups: group A; without loss of connection between scapula and clavicle (mainly types I and II), and group B; with loss of the same (majority of types III and IV).

Adolescent↗