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At least 109 records · Page 6Linked to original sources
PubMed2005

Comparison of radial forearm with fibula and scapula osteocutaneous free flaps for oromandibular reconstruction.

OBJECTIVE: To compare our experience with the osteocutaneous radial forearm free flap (group 1) (n = 108) with other commonly used osteocutaneous free flaps (group 2) (n = 56) such as the fibula and scapula in single-stage oromandibular reconstruction. DESIGN: Retrospective case review. SETTING: Tertiary-care academic medical center. PATIENTS: One hundred sixty-three consecutive patients who underwent 164 mandibular reconstructions with osteocutaneous free flaps. MAIN OUTCOME MEASURES: Assessment of preoperative and intraoperative variables for both groups. We compared recipient-site complication rate, intensive care unit stay, total hospital stay, and postoperative function. RESULTS: The most common donor site used was the radius (n = 108 [66%]), followed by the fibula (n = 36 [22%]) and scapula (n = 20 [12%]). Mean follow-up was 29 months (range, 1-116 months). Group 2 patients had larger soft tissue and/or bony defects. Surgical and medical complication rates and major donor site morbidity in group 1 were similar or better when compared with those in group 2. The lengths of the intensive care unit (4 vs 7 days; P = .009) and hospital stays (13 vs 15 days; P = .06) were shorter in group 1. Although the microvascular success rate was similar in both groups, the local wound complication rate was significantly better for group 1. The difference for the length of intensive care unit stay was statistically significant and potentially amounts to more than 6000 dollars of savings. Functional outcomes, including the ability to tolerate oral diet, tracheostomy presence, and dental rehabilitation, were similar between the groups. CONCLUSIONS: The primary site long-term morbidity, donor site morbidity, and postoperative function of osteocutaneous radial forearm free flaps are comparable to those of other commonly used osteocutaneous free flaps such as the fibula and scapula when used in single-stage oromandibular reconstruction.

Adolescent↗
PubMed1995

New characters for the functional interpretation of primate scapulae and proximal humeri.

The study of muscle function in nonhuman primates through the technique of electromyography (EMG) has facilitated the identification of specific functional roles for muscles in particular behaviors. This has led to a more complete understanding of the biomechanics of certain regions of the musculoskeletal system, and should facilitate our ability to identify morphological features useful in the functional interpretation of fossil material. The current paper represents one such investigation of a new set of morphometric characters of the scapula and proximal humerus suggested by EMG analyses of shoulder muscle function. A set of new metric variables were examined on the scapulae and proximal humeri of 25 species of extant anthropoid primates, as well as on casts of scapulae and humeri of three fossil primate taxa. The variables are primarily related to the line of action and attachments of the rotator cuff muscles. The position of the scapular spine, the degree of lateral expansion of the subscapular fossa, the size and shape of the subscapularis insertion facet on the lesser tubercle, and the orientation of the infraspinatus insertion facet on the greater tubercle all appear to successfully sort the extant taxa into locomotor groups. Their appearance on the fossil specimens generally supports previous functional interpretations of each taxon's locomotor abilities based on a variety of other characters, suggesting that these traits are equally applicable to fossil material.

Animals↗
PubMed1987

Duplication of the scapula.

Complete duplication of the scapula has not been described. We report two children both of whom had duplication of their right scapula associated with other malformations. In each case an operation was done to fuse the two abnormal scapulae together and the results were good.

Child, Preschool↗
PubMed1983

Radiology of postnatal skeletal development. VII. The scapula.

Twenty-four pairs of scapulae from fetal specimens and 35 pairs of scapulae from postnatal cadavers ranging in age from full-term neonates to 14 years, were studied morphologically and roentgenographically. Air-cartilage interfacing was used to demonstrate both the osseous and cartilaginous contours. When the entire chondro-osseous dimensions, rather than just the osseous dimensions, were measured, the scapula had a height-width ratio ranging from 1.36 to 1.52 (average 1.44) during most of fetal development. The exceptions were three stillborns with camptomelic, thanatophoric, and achondrogenic dwarfism in which the ratio averaged 0.6. At no time during fetal development was the glenoid cavity convex; it always had a concave articular surface. However, the osseous subchrondral countour was often flat or slightly convex. In the postnatal period the height-width ratio averaged 1.49. The ratio remained virtually unchanged throughout skeletal growth and maturation. In a patient with unilateral Sprengel's deformity the ratio for the normal side was 1.5, while the abnormal was 1.0. The cartilaginous glenoid cavity was always concave during postnatal development, even in the specimens with major structural deformities, although the subchondral osseous contour was usually flat or convex during the first few years of postnatal development. Ossification of the coracoid process began with the development of a primary center at three to four months. A bipolar physis was present between the primary coracoid center and the primary scapular center until late adolescence.

Acromion↗
PubMed1994

The value of computed tomography in the diagnosis of grating scapula.

Snapping or grating scapula is a condition of the shoulder girdle in which the patient complains of pain and an audible snapping sound which may be associated with pain. We evaluated the diagnostic value of the computed tomography (CT) scans using the clinical diagnosis of a grating scapula as the gold standard. This retrospective study reports the sensitivity, specificity, likelihood ratio and receiver operator characteristic curve for the CT scans and the kappa value as a measure of the interobserver agreement. None of the parameters validated the examination. We therefore concluded that CT scans are inappropriate for differentiation between a grating scapula and a normally functioning shoulder except in cases where bony abnormalities are present.

Adult↗
PubMed2005

[Solitary osteochondroma of the scapula. A rare differential diagnosis with unspecific shoulder pain].

Solitary osteochondroma of the scapula is rare. Because of the atypical location with unspecific shoulder pain, the diagnosis is often made late. We present a 35 year old patient with a solitary ostochondroma of the scapula with unspecific pain of the shoulder-neck region over about 4 years. In a thorax x-ray 2 years ago, a tumor like lesion was found. CT and MRI scan led to suspicion of a solitary osteochondroma of the scapula. Because of progressive thoracic pressure pain, a wide excision was made. The problems of diagnosis and therapy are presented and the literature is discussed.

Adult↗
PubMed2006

Winged scapula as the presenting symptom of Chiari I malformation and syringomyelia.

CASE REPORT: We report a 19-year-old girl with a 4-month history of an inability to fully elevate her upper extremity past the horizontal position. Physical examination revealed a winged scapula. MRI was demonstrative of a Chiari I malformation with a small cervical syrinx eccentrically placed to the same side as the dysfunctional extremity. DISCUSSION: We believe this to be the first report of dysfunction of the long thoracic nerve via a hindbrain hernia-induced syrinx with a resultant winged scapula. We would hypothesize that enough anterior horn motor neurons and their axons destined for the long thoracic nerve were injured by the syringomyelia to result in isolated deinnervation of the serratus anterior muscle. CONCLUSION: The clinician may wish to include syringomyelia in the differential diagnosis of a winged scapula.

Adult↗
PubMed2005

A 3D finite element model of an implanted scapula: importance of a multiparametric validation using experimental data.

In order to help to understand the loosening phenomenon around glenoïd prostheses, a 3D finite element model of a previously tested implanted scapula has been developed. The construction of the model was done using CT scans of the tested scapula. Different bone material properties were tested and shell elements or 8 nodes hexaedric elements were used to model the cortical bone. Surface contact elements were introduced on one hand between the bone and the lower part of the plate of the implant, and on the other, between the loading metallic ball and the upper surface of the implant. The results of the model were compared with those issued from in vitro experiments carried out on the same scapula. The evaluation of the model was done for nine cases of loading of 500 N distributed on the implant, in terms of strains (principal strains of six spots around peripheral cortex of the glenoïd) and displacement of four points positioned on the implant. The best configuration of the model presented here, fits with experiments for most of the strains (difference lower than 150microdef) but it seems to be still too stiff (mainly in the lower part). Nevertheless, we want, in this paper, to underline the importance of doing a multiparametric validation for such a model. Indeed, some models can give correct results for one case of loading but bad results for another kind of loading, some others can give good results for one kind of compared parameters (like strains for instance) but bad results for the other one (like displacements).

Aged↗
PubMed2006

Three-dimensional rotation of the scapula during functional movements: an in vivo study in healthy volunteers.

The goal of this study was to measure 3-dimensional shoulder motion by use of a direct invasive technique during 4 different arm movements in healthy volunteers. Eight subjects with healthy shoulders were recruited. Optoelectronic marker carriers (ie, infrared light-emitting diodes) were mounted on bone pins, which were inserted into the lateral scapular spine. Subjects performed 4 different arm movements while the motion was being recorded by a precision optoelectronic camera. Joint angles were calculated in 3 dimensions. Intraclass correlation coefficients and root-mean-square differences were calculated as measures of reliability. During abduction, the scapula tipped posteriorly (44 degrees +/- 11 degrees), rotated upward (49 degrees +/- 7 degrees), and rotated externally (27 degrees +/- 11 degrees). For reaching, the scapula consistently rotated upward (17 degrees +/- 3 degrees) and rotated internally (18 degrees +/- 6 degrees) whereas tipping was generally less than 10 degrees (5 degrees +/- 2 degrees). Overall, the range of scapular movement for the hand behind the back was small and variable, with most rotations not exceeding 15 degrees. For horizontal adduction, the scapula tipped anteriorly (8 degrees +/- 3 degrees), rotated upward (5 degrees +/- 2 degrees), and rotated internally (27 degrees +/- 6 degrees). These scapular rotations provide normative data that will be useful for diagnosing scapular dysfunction.

Adult↗
PubMed1998

Scapula winger's brace: a case series on the management of long thoracic nerve palsy.

OBJECTIVE: To evaluate the clinical utility of a new scapula winger's brace. DESIGN: A case series. SETTING: A tertiary military clinic serving a young population. PARTICIPANTS: Fourteen patients referred to the clinic for thoracic nerve palsy of a least 3 months' duration. OUTCOME MEASURES: Manual muscle tests with and without the brace and patients' compliance/satisfaction with brace as measured by personal interview during follow-up. RESULTS: Muscle strength increased by one grade with brace application; patients who maintained compliance (n = 6) recovered their brace-free shoulder flexion strength and/or had reduced pain at the last follow-up (1 to 7 months after brace). All patients reported a subjective feeling of increased shoulder flexion strength and decreased pain with brace application. CONCLUSION: The scapula winger's brace is a useful tool for physiatrists in the management of scapular winging secondary to long thoracic nerve palsy. Additional studies are needed to confirm the conclusion that the device's benefits derive from proprioceptive feedback that prevents muscle overuse or overstretch and from its transfer of contralateral shoulder protraction force to the affected scapula.

Adult↗
PubMed2001

Finite element analysis of the mechanical behavior of a scapula implanted with a glenoid prosthesis.

OBJECTIVE: The objective of the present study was to analyze the mechanical effect of some of the surgical variables encountered during shoulder arthroplasty using the finite element method. The effect of one eccentric load case, cement thickness and conformity has been investigated. DESIGN: A 3D finite element model of a healthy cadaveric scapula implanted with an anatomically shaped glenoid has been developed from computed tomography (CT) images. BACKGROUND: Glenoid component fixation can present the most difficult problem in total shoulder arthroplasty, loosening of this component remains one of the main complications. METHODS: The 3D finite element model was first validated by comparison with experimental measurements and by fitting of the mechanical properties of the cortical bone. Then the articular pressure location, the surface contact geometry and the cement thickness have been analyzed to observe their effect on stresses and displacements at the interfaces and within the scapular bone. RESULTS: The antero-posterior bending of the scapula was a notable feature and this was accentuated when an eccentric load was applied. The gleno-humeral contact area had a major role on the stress level in the supporting structures though but not on the global displacements. Varying the cement mantle modified stresses according to the load case and it essentially changed the latero-medial displacement of the cement relatively to the bone. CONCLUSIONS: This analysis provided an insight into the mechanical effects of an implanted scapula according to different parameters related to implantation technique. RELEVANCE: Results emphasized the role of some of the parameters a clinician may face. They demonstrated the importance of the humeral head centering in the horizontal plane. Conformity decreasing may involve drastic increase of stresses within structures and a thick cement mantle is not necessarily advantageous relatively to the stresses at the cement/bone interface.

Arthroplasty↗
PubMed1999

Effect of different arm loads on the position of the scapula in abduction postures.

OBJECTIVE: The objective of this study is to determine the relation between arm load and the three-dimensional shoulder orientations. BACKGROUND: Analysis of a musculo-skeletal system by means of an inverse dynamical simulation requires postural data of the bony elements involved. For the shoulder, the positions of the clavicle and the scapula are difficult to record due to the skin displacement. It would therefore be useful to predict the three-dimensional relation between the orientation of the arm, the clavicula and the scapula, i.e. the three-dimensional shoulder rhythm, with respect to the thorax under different load conditions. METHODS: The orientation of the clavicula and the scapula was determined with respect to the thorax by means of palpation of skeletal landmarks, for seven postures of arm elevation in the frontal plane at four load conditions: 0, 0.9, 1.9 and 2.9 kg at the wrist. The data were expressed by Cardan angles and analyzed by means of repeated measurements analysis of variance. RESULTS: While the clavicular and scapular angles were significantly related to the arm elevation, no significant relation was found with the load in the hands for the seven arm postures. CONCLUSIONS: The three-dimensional shoulder rhythm does not change under different gravitational load conditions on the arm. RELEVANCE: The fact that the magnitude of the load does not affect the shoulder postures, i.e. the moment arms of the muscles, facilitates the biomechanical, ergonomical and clinical studies on the shoulder by the reduction on the number of recordings for equal task under different load conditions, and easy imitation of real life tasks in the laboratory.

Adult↗
PubMed1997

The glenoid notch and its relation to the shape of the glenoid cavity of the scapula.

The prevalence of a notch in the anterior margin of the glenoid cavity of 236 scapulae (118 female, 118 male) was investigated. The notch was found in 129 scapulae (55%) and gave rise to a pear-shaped cavity. In 107 scapulae (45%) the notch was absent, the shape of the cavity being oval. No sex difference was found in the prevalence of the notch. If a distinct notch exists, the glenoid labrum is not attached to bone at the notch and is therefore liable to be sheared off (Bankart lesion).

Female↗
PubMed2003

Bone response to unloaded titanium implants in the fibula, iliac crest, and scapula: an animal study in the Yorkshire pig.

The reconstruction of extended maxillary and mandibular defects with prefabricated free flaps is a two stage procedure, that allows immediate function with implant supported dentures. The appropriate delay between prefabrication and reconstruction depends on the interfacial strength of the bone-implant surface. The purpose of this animal study was to evaluate the removal torque of unloaded titanium implants in the fibula, the scapula and the iliac crest. Ninety implants with a sandblasted and acid-etched (SLA) surface were tested after healing periods of 3, 6, and 12 weeks, respectively. Removal torque values (RTV) were collected using a computerized counterclockwise torque driver. The bicortical anchored 8mm implants in the fibula revealed values of 63.73 Ncm, 91.50 Ncm, and 101.83 Ncm at 3, 6, and 12 weeks, respectively. The monocortical anchorage in the iliac crest showed values of 71.40 Ncm, 63.14 Ncm, and 61.59 Ncm with 12 mm implants at the corresponding times. The monocortical anchorage in the scapula demonstrated mean RTV of 62.28 Ncm, 97.63 Ncm, and 99.7 Ncm with 12 mm implants at 3, 6, and 12 weeks, respectively. The study showed an increase of removal torque with increasing healing time. The interfacial strength for bicortical anchored 8mm implants in the fibula was comparable to monocortical anchored 12 mm implants in the iliac crest and the scapula at the corresponding times. The resistance to shear seemed to be determined by the type of anchorage (monocortical vs. bicortical) and the length of the implant with greater amount of bone-implant interface.

Animals↗
PubMed1999

Large bursa formation associated with osteochondroma of the scapula: a case report and review of the literature.

Bursitis or large bursa formation associated with osteochondroma has rarely been reported. A 33-year-old male presented with upper back pain, a rapidly developing mass beside the lateral border of his right scapula and snapping elicited by movement of the scapula. Plain radiograms and CT revealed osteochondroma on the ventral surface of the scapula without any unmineralized component and a huge cystic lesion around the osteochondroma. Aspiration of the cystic lesion showed the presence of sero-sanguineous fluid. MRI following the aspiration showed a thin cartilaginous cap with distinct outer margin and no soft tissue mass around the cap. Pathological examinations confirmed the diagnosis of osteochondroma with the large bursa formation. Clinical examination 19 months postoperatively showed an uneventful clinical course.

Adult↗
PubMed2002

Determination of sex from the clavicle and scapula in a Guatemalan contemporary rural indigenous population.

The clavicle has been described as a useful bone for the metric determination of sex of human skeletal remains in a contemporary, predominantly white, North American forensic sample. In this article, measurements of clavicle and scapula are provided for a contemporary Guatemalan rural indigenous sample of forensic origin. Maximum length and circumference at midshaft of the clavicle, and height and width of the glenoid fossa of the scapula, were measured in 35 female and 62 male clavicles, and in 38 female and 65 male scapulae. Discriminant function analysis was used to study sexual dimorphism in this population with a classification purpose. Leave-one-out method (jackknife) matrices produced classification success rates ranging from 85.6% to 94.8%. A comparison with the North American forensic sample showed low percentages of correctly sexed Guatemalan male clavicles, ranging from 29.4% to 54.9%. The choice of an appropriate standard for the metric determination of sex is a crucial step in forensic anthropology.

Anthropometry↗
PubMedDate not supplied

A modified judet approach to the scapula.

Operative treatment of scapula fractures is uncommon, but is indicated for significantly displaced fractures or intra-articular fractures. This modified Judet approach for exposure of scapula fractures combines several important goals: 1) exposure of all bony elements of the scapula which have adequate bone stock for internal fixation; 2) minimal trauma to the rotator cuff musculature; and 3) protection of the major neurologic structures (suprascapular nerve superiorly and axillary nerve laterally). The main advantage of the exposure is limiting muscular dissection, which can potentially improve rehabilitation and limit morbidity of the operation.

Fracture Fixation↗
PubMed1980

Fractures of the scapula.

One hundred thirty-seven fractures of the scapula in 121 patients were reviewed. The average age at the time of injury was 35 years, with fractures predominant in males (64%). The majority of cases (43%) involved fractures of the body of the scapula, with fractures of the scapular neck being second most common (26%). Automobile accidents produced the most injuries (52%), followed by auto-pedestrian (18%), falls (12%), and motorcycle accidents (11%). Associated bony or major soft-tissue trauma was present in all but 15 of the 121 patients, the most common being fractured ribs in 44%. Other associated injuries included fractures of the clavicle (26%), fractured skull (24%), cerebral contusion (20%), neurologic deficit (13%), and pulmonary contusion or hemo-pneumothorax (16%). Patients with injuries involving the acromion process or acromioclavicular joint had a significantly higher incidence of associated peripheral nerve injuries than those with other fractures of the scapula, indicating that special attention should be given to the neurologic examination of patients with these fractures. Careful neurovascular examination is mandatory. Treatment was usually conservative, independent of the location of the fracture, with satisfactory long-term results. We recommend simple immobilization followed by early active range of motion exercise.

Adolescent↗