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At least 145 records · Page 8Linked to original sources
PubMed2007

Scapula osteocutaneous free flap reconstruction of the head and neck: impact of flap choice on surgical and medical complications.

BACKGROUND: The scapula osteocutaneous free flap is frequently used to reconstruct complex head and neck defects given its tissue versatility. Because of minimal atherosclerotic changes in its vascular pedicle, this flap also may be used as a second choice when other osseous flaps are not available because of vascular disease at a preferred donor site. METHODS: We performed a retrospective chart review evaluating flap outcome as well as surgical and medical complications based upon the flap choice. RESULTS: The flap survival rate was 97%. The surgical complication rate was similar for the 21 first-choice flaps (57.1%) and the 12 second-choice flaps (41.7%; p = .481). However, patients having second-choice flaps had a higher rate of medical complications (66.7%) than those with first-choice flaps (28.6%; p = .066). Age and the presence of comorbidities were associated with increased medical complications. All patients with comorbidities that had a second-choice flap experienced medical complications, with most being severe. CONCLUSIONS: The scapula osteocutaneous free flap has a high success rate in head and neck reconstruction. Surgical complications occur frequently regardless of whether the flap is used as a first or second choice. However, medical complications are more frequent and severe in patients undergoing second-choice flaps.

Adolescent↗
PubMed2001

Agenesis of the scapula in Emx2 homozygous mutants.

The shoulder and pelvic girdles represent the proximal bones of the appendicular skeleton that connect the anterior and posterior limbs to the body trunk. Although the limb is a well-known model in developmental biology, the genetic mechanisms controlling the development of the more proximal elements of the appendicular skeleton are still unknown. The knock-out of Pax1 has shown that this gene is involved in patterning the acromion, while the expression pattern candidates Hoxc6 as a gene involved in scapula development. Surprisingly, we have found that scapula and ilium do not develop in Emx2 knock-out mice. In the homozygous mutants, developmental abnormalities of the brain cortex, the most anterior structure of the primary axis of the body, are associated with important defects of the girdles, the more proximal elements of the secondary axis. These abnormalities suggest that the molecular mechanisms patterning the more proximal elements of the limb axis are different from those patterning the rest of appendicular skeleton. While Hox genes specify the different segments of the more distal part of the appendicular skeleton forming the limb, Emx2 is concerned with the more proximal elements constituting the girdles.

Animals↗
PubMedDate not supplied

Clavicles, scapulae and humeri from the Sima de los Huesos site (Sierra de Atapuerca, Spain).

The scapulae, clavicles and humeri recovered from the Sima de los Huesos (SH) site between 1976 and 1994 are studied. All elements are briefly described anatomically with metrics and compared with other fossil hominids in order to establish the morphological pattern of the SH hominids. A minimum of 13 individuals are represented by the humeri in the SH sample. Almost all of them can be classified as adolescents and young adults. The morphology of the SH hominid shoulder girdle and humeri indicates that much of the shoulder morphology recognized in the later true Neandertal was present in Europe long before they appeared. Thus, this morphological pattern is not exclusive to Neandertals alone. The SH clavicles, scapulae and humeri share with the Neandertals many traits usually considered to be Neandertal specializations. The comparative analysis of the SH evidence suggests that most of the SH and Neandertal shared traits are either primitive features within the genus Homo or even for all hominids, or display high variability within different hominid samples. These traits must be used with caution, or not used at all, in phylogenetic analysis. There are, however, traits that to date have only been detected in the SH hominids and the Neanderials, which could be exclusive to the European phyletic lineage (clade) of Homo.

Adolescent↗
PubMed1988

[Sexual dimorphism of the scapula].

Studies on 96 male and 53 female human right scapulas confirmed a highly significant sexual dimorphism. This sexual dimorphism could also be ascertained for 23 pairs of scapulas from male and female individuals with identical body height. It therefore depends not only on the different average stature of men and women. Using the presented quantitative criteria, the sex of 88% of the bones could be determined correctly, while 4% were misclassified.

Adolescent↗
PubMed1982

Avulsion fractures of the scapula.

Fractures of the scapula due to direct violence are relatively common. Wilber and Evans [18] reported 40 scapular fractures and reviewed the literature. All those injured had received direct trauma to the shoulder and they were able to divide their cases into two groups, based on anatomical location and functional results. Scapular fractures due to avulsion of the muscular attachments are uncommon and, as reports of these injuries in the literature are usually confined to single cases, no classification has been established which takes account of the anatomical sites at which these fractures occur and the mechanism of injury involved. In this paper the more common sites of avulsion injury of the scapula are described and illustrated by case reports. In several of these the skeletal injury resulted from muscle contraction against a resisted force on the upper limb during the course of an accident. This mechanism has been implicated in fractures of the coracoid and acromion, but is shown in this paper to contribute to other avulsion fractures.

Adolescent↗
PubMed2004

[Fractures of the scapula].

Two thirds of the fractures of the scapula refer to its body, one third to its neck, and one forth to the glenoid. They are indicative of high-energy blunt trauma. Traffic injuries are their main cause. Associated ipsilateral upper torso injuries are common and have to be considered!Scapular fractures may be classified as being extra- or intraarticular. Extraarticular fractures concern the scapular body, its processes, or the scapular neck. A fracture of the surgical neck of the scapula accompanied by an injury to the coracoclavicular connection is regarded as a "floating shoulder". In this case the broken suspension of the glenoid has to be reconstructed. Most intraarticular fractures are of the Bankart variety, where a shoulder dislocation spreads an oblique fragment of the glenoid. They should be treated by internal fixation, if the size of the fragment is bigger than 16 mm. Where surgery is advisable, an appropriate approach has to be chosen depending on the type of the fracture. The anterior approach of Neer and the dorsolateral approach of Brodsky are very suitable. As a basic principle dislocated or unstable fractures of the scapular processes and of the glenoid should be treated by internal fixation, since their functional result may be less than fair if they are treated conservatively. Most other fractures heal uneventful under a conservative regimen.

Accidents, Traffic↗
PubMed2005

Giant chondroblastoma of the scapula with pulmonary metastases.

A 53-year-old man presented with a 12-year history of a progressively growing solid mass at his left shoulder. A 39x30x18-cm and 14.440-kg mass including the scapula was resected. Pathologic features were specific for chondroblastoma. During the 36-month follow-up, he had multiple inoperable metastatic lesions in his lungs. Histology of the transthoracic needle biopsy showed the metastatic nodules had features specific for chondroblastoma; however, the microscopic features additionally had hyperchromasia and increased mitotic activity in some areas. In the English literature, there are a few cases of chondroblastoma located in the scapula. It is exceptional to see this lesion in the sixth decade of life and with pulmonary metastases.

Bone Neoplasms↗
PubMed2006

Toxic osteoblastoma of the scapula.

Osteoblastoma rarely occurs in the scapula, and toxic osteoblastoma is a very rare subtype of this bone-forming tumour. This report details the clinical, radiological and pathological features of a toxic osteoblastoma of the scapula; it is the first reported case to be diagnosed correctly pre-operatively and treated appropriately by excision.

Biopsy↗
PubMed2000

Tuberculous osteomyelitis of the scapula.

Tuberculous osteomyelitis is an uncommon disease entity. We report two cases of tuberculous infection of the scapula, one involving the acromion and one involving the body of the scapula. Tuberculosis is still an important differential diagnosis in unusual or chronic bone conditions.

Adult↗
PubMed2005

Fractures of the scapula surgical neck: outcome after conservative treatment in 13 cases.

BACKGROUND: Conservative treatment of fractures of the scapular neck does not uniformly lead to a success. The purpose of this retrospective study was to analyze the occurrence of glenoid displacement in conservatively treated patients with a scapular neck fracture without concomitant shoulder girdle injury in relation with the clinical outcome. METHODS: Between 1991 and 2001, 177 patients with a fracture of the scapula were treated in two Dutch clinics. Twenty-four patients sustained a scapular neck fracture, who all, with the exception of one, were treated non-operatively. At follow-up, 13 patients had a functional evaluation and were assessed clinically at an average of 5.5 years after the injury. RESULTS: All fractures healed uneventfully. At final radiographic evaluation, four patients were found with significant translational displacement of fracture fragments (>1 cm); however, no angular displacement of the glenoid was found (no GPA < 20 degrees ). The functional outcome of the 13 patients was excellent (Constant score: 90). No correlation was found between functional outcome and malunion. There was no significant difference between the SF-36 scores in the follow-up group and the scores for age-matched controls in the general population. CONCLUSIONS: Non-operative treatment of a surgical neck fracture of the scapula in absence of an ipsilateral shoulder injury and associated permanent neurological impairment leads to a good to excellent functional outcome, with or without significant translational displacement.

Adolescent↗
PubMed2000

Seventeen-year follow-up of massive osteolysis of the scapula.

A 14-year-old boy with massive osteolysis of the right scapula was treated by irradiation with a total dose of 58 Gy, using cobalt 60 (2 Gy per fraction) in 1983 and 1984. Histopathology in a biopsy specimen revealed hemangiomatosis associated with few osteoclasts and a lining of oval or spindle-shaped endothelial-like cells. The osteolysis has been interrupted since the last irradiation. In January 2000, 17 years after the initial treatment, the patient is working as a public officer, and shows no clinical signs of postradiation sarcoma. Radiographs show a residual scapula with sclerotic margin, associated with marked hypoplasia and atrophy of the right humerus. Ranges of motion of the right shoulder are 100 degrees on anterior elevation, 40 degrees on posterior elevation, and 70 degrees on abduction. The patient experiences no problems in daily living, except for difficulty in lifting.

Adolescent↗
PubMed2001

[Stability of dental implants in microvascular scapula and iliac crest transplants].

STUDY: In this study 24 patients with tumours of the mandible, mandibular resection, neck dissection and reconstruction by microvascular iliac crest (13) or scapula transplants (11) were examined following implantological treatment. RESULTS: In all patients the implantological examination was performed on average two years and five months after implant insertion. This allowed for observation of periotest values, periimplant probing depth and sulcus bleeding (SBI). Furthermore, the loss of periimplant bone was registered radiologically. In both groups periotest values were normal. In the group with scapular transplants the mean periotest value was -3.2 and in the other group -0.8. Pathological probing depth was registered in both groups and sulcus bleeding was similar. The loss of periimplant crestal bone was similar in both groups, too. DISCUSSION: It can thus be concluded that perimimplant conditions were equal in both groups two years after implant loading. The stability of implants in scapula transplants was higher than in iliac crest transplants.

Alveoloplasty↗
PubMed2004

Preliminary analysis of Nacholapithecus scapula and clavicle from Nachola, Kenya.

The Miocene ape Nacholapithecus is known from rather complete skeletons; some of them preserve the shoulder joint, identified by three scapulae and one clavicle. Comparisons made with other Miocene and living apes ( Proconsul, Equatorius, Ugandapithecus) suggest that the mobility of the scapulohumeral joint was important, and scapular features such as the morphology and position of the spine and the morphology of the acromion and axillary border resemble those of climbing arboreal primates except for chimpanzees, gorillas, or orang-utans. From the size of the scapula (male Nasalis size), it is clear that the animal is smaller than an adult chimpanzee, but the clavicle is almost as relatively long as those of chimpanzees. Some features closer to colobine morphology reinforce the hypothesis that Nacholapithecus was probably a good climber and was definitely adapted for an arboreal life.

Animals↗
PubMed1984

The fractured scapula: importance and management based on a series of 62 patients.

A prospective analysis of 62 patients with 64 fractured scapulas is presented. Most cases are caused by severe injury, especially motor vehicle accidents. Of the total number of patients, 87.1 per cent had other injuries, with thoracic injury being especially common. Six patients died--a mortality rate of 9.7 per cent. The combination of a fracture of the scapula and the underlying first rib appears to be a particularly severe injury. Good results can be obtained with conservative therapy in fractures of the body, spine, coracoid and acromion. Less favourable results follow fractures of the neck and glenoid. In young and fit patients open reduction may be indicated in fractures of the neck and glenoid.

Adolescent↗
PubMed2006

Arthroscopic management of the painful snapping scapula.

PURPOSE: The aim of this study was to evaluate the results of the arthroscopic management of the snapping scapula syndrome. TYPE OF STUDY: Case series. METHODS: Thirteen patients underwent surgery for painful scapular snapping that had not responded to adequate conservative treatment. They had no evidence of anatomic abnormalities on plain radiographs. All patients underwent bursectomy and resection of bands of fibrous tissue at the superomedial angle. Bone was resected from the superomedial angle only if it appeared to be prominent during arthroscopy. This occurred in 3 cases. The patients' outcomes were assessed subjectively by their ability to return to work and their return to leisure, as well as the Constant score. RESULTS: At the time of follow-up, 9 patients (69%) reported an improvement in their symptoms. Their median Constant score was 87 (range, 95 to 58). Four patients felt that their symptoms were unchanged or worse. Their median Constant score was 55 (range, 66 to 32). Of 9 employed patients, 8 returned to their previous careers. This group included 2 patients with physically demanding jobs. Of 9 patients who played sports regularly, 6 returned to their presymptomatic level of sporting activity. There were no complications. CONCLUSIONS: Subscapular bursectomy is a safe procedure with a low rate of morbidity. In the absence of a definable anatomic abnormality, arthroscopic bursectomy for the painful snapping scapula can result in satisfactory outcomes in approximately 70% of patients. More clearly defined indications for and contraindications against surgery are required to avoid poor results. Complete resolution of the snapping in the subscapular bursa is not necessary to obtain a satisfactory result. LEVEL OF EVIDENCE: Level IV, case series, no control group.

Adult↗
PubMed2004

The relative contribution of cysteine proteinases and matrix metalloproteinases to the resorption process in osteoclasts derived from long bone and scapula.

It has been suggested that functional heterogeneity exists between osteoclasts from different bone sites. This could be exploited to design therapeutics that would selectively inhibit bone resorption only at compromised sites. To further investigate the existence of functional differences between osteoclasts from different bone sites we assessed whether osteoclasts isolated from intramembranous bone differ from osteoclasts isolated from endochondral bone in the extent that they utilize cysteine proteinases and matrix metalloproteinases to degrade the organic matrix of bone. The differential involvement of the two classes of proteases was assessed by analyzing dose-dependent effects of the matrix metalloproteinase inhibitor, CT-1746, and of the cathepsin inhibitor, E64, on bone resorption. Osteoclasts isolated from the scapula (intramembranous) and long bones (endochondral) of newborn New Zealand white rabbits were seeded on cortical bovine bone slices in the presence or absence of inhibitors. Resorptive activity was evaluated by measuring the number and area of resorption pits and by measuring the release of collagen degradation products in the culture medium. In the absence of inhibitors, scapular osteoclasts and long bone osteoclasts had similar activity based on these criteria. The resorptive activity of scapular osteoclasts was inhibited to a greater extent by the MMP inhibitor CT-1746 than by the cysteine proteinase inhibitor E64. Conversely, resorption by osteoclasts derived from long bones was inhibited to a greater degree by the cysteine proteinase inhibitor. These results strongly suggest that there are functional differences between dispersed osteoclasts derived from the scapula and long bones, with scapular osteoclasts utilizing matrix metalloproteinases to a greater extent than cysteine proteinases and long bone osteoclasts using cysteine proteinases to a greater extent than matrix metalloproteinases.

Amides↗
PubMed2005

Winged scapula in the emergency department: a case report and review.

Winged scapula is a well-described condition associated with a wide variety of injuries and conditions. It is typically due to dysfunction of the serratus anterior or trapezius muscles, often secondary to long thoracic or accessory nerve palsies. Given the potential for permanent disability, winged scapula is an important diagnosis to consider in any patient presenting with shoulder pain or weakness.

Adult↗