OPPOSITE Judet APPROACH FOR INTERNAL FIXATION OF SCAPULA NECK AND BODY FRACTURES WITH RECONSTRUCTION PLATE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TONGWenqing ,  DONGYouhai , WUJunguo

Department of Orthopaedics, Shanghai Fifth People's Hospital Affiliated to Fudan University, Shanghai, 200240, P. R. China;

Corresponding author：

DONGYouhai, Email: losary@126.com

Keywords：

Scapula fracture; Opposite Judet approach; Internal fixation

DOI：

10.7507/1002-1892.20140146

Video：

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Objective To investigate the effectiveness of the opposite Judet approach for internal fixation of scapula neck and body fractures with reconstruction plate. Methods Between February 2008 and November 2012, 44 cases of scapula neck and body fractures were treated through the opposite Judet approach for internal fixation with reconstruction plate. There were 34 males and 10 females with a mean age of 31 years (range, 20-53 years). Fractures were caused by traffic accident in 30 cases, by falling from height in 10 cases, and by crashing of heavy object in 4 cases. Of 44 cases, 6 were classified as type Ⅱ A, 14 as type Ⅱ B, 4 as type Ⅱ C, and 20 as type Ⅳ fractures according to Miller standard. The mean time between operation and trauma was 11 days (range, 5-20 days). The glenopolar angle and the glenoid bank angle were measured on the anterior scapula X-ray films. The shoulder functions were evaluated according to the Rowe's scoring system. Results The mean operation time was 80 minutes (range, 60-110 minutes). The mean intraoperative blood loss was 200 mL (range, 100-400 mL). Superficial wound infection occurred in 2 cases at 5 days after operation, and was cured after change dressing without dysfunction. Primary healing of incision was obtained in the other cases. All cases were followed up 12-23 months (mean, 18.3 months). No nerve or blood vessel injury, breakage of internal fixation, fracture displacement, bone nonunion, or osteomyelitis occurred. The glenopolar angle and glenoid bank angle were significantly improved from (17.08±3.28)°and (23.52±4.35)°before operation to (36.24±5.89)°and (9.27±2.12)°at 6 months after operation respectively (t=18.792, P=0.001;t=19.503, P=0.001). According to Rowe's scoring system for evaluation of shoulder function, the results were excellent in 32 cases, good in 8 cases, and fair in 4 cases at 1 year after operation; the excellent and 6 months good rate was 90.9%. Conclusion Opposite Judet approach for internal fixation of scapula neck and body fractures with reconstruction plate has the advantages of less rotator cuff injury, complete exposure of the scapula two column structure through the three gaps, and easy operation, and the satisfactory fracture reduction and rigid fixation can be obtained.

Citation： TONGWenqing, DONGYouhai, WUJunguo. OPPOSITE Judet APPROACH FOR INTERNAL FIXATION OF SCAPULA NECK AND BODY FRACTURES WITH RECONSTRUCTION PLATE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(6): 661-664. doi: 10.7507/1002-1892.20140146 Copy

1.	Lapner PC, Uhthoff HK, Papp S. Scapula fractures. Orthop Clin North Am, 2008, 39(4):459-474.
2.	Bahk MS, Kuhn JE, Galatz LM, et al. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. J Bone Joint Surg (Am), 2009, 91(10):2492-2510.
3.	Miller ME, Ada JR. Injurie to the shoulder girdle//Browner BD, Levinen AM, Jupiter JB. Skeletal Trauma. 2nd ed. Philadephia:WB Saunder, 1998:1657-1670.
4.	Harvey E, Audigé L, Herscovici D Jr, et al. Development and validation of the new international classification for scapula fractures. J Orthop Trauma, 2012, 26(6):364-369.
5.	Rowe CR. Evaluation of the shoulder//Rowe CR. The shoulder. New York:Churchill Livingstone, 1988:631-637.
6.	Dimitroulias A, Molinero KG, Krenk DE, et al. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res, 2011, 469(5):1459-1465.
7.	Schofer MD, Sehrt AC, Timmesfeld N, et al. Fractures of the scapula:long-term results after conservative treatment. Arch Orthop Trauma Surg, 2009, 129(11):1511-1519.
8.	van Noort A, van Kampen A. Fractures of the scapula surgical neck:outcome after conservative treatment in 13 cases. Arch Orthop Trauma Surg, 2005, 125(10):696-700.
9.	Anavian J, Gauger EM, Schroder LK, et al. Surgical and functional outcomes after operative management of complex and displaced intrsarticular glenoid fractures. J Bone Joint Surg (Am), 2012, 94(7):645-653.
10.	Schandelmaier P, Blauth M, Schneider C, et al. Fractures of the glenoid treated by operation. J Bone Joint Surg (Br), 2002, 84(2):173-177.
11.	Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg, 2012, 20(3):130-141.
12.	Lantry JM, Roberts CS, Giannoudis PV. Operative treatment of scapula fractures:a systematic review. Injury, 2008, 39(3):271-283.
13.	Cole PA, Talbot M, Schroder LK, et al. Extra-articular malunions of the scapula:a comparison of functional outcome before and after reconstruction. J Orthop Trauma, 2011, 25(11):649-656.
14.	Ebraheim NA, Mekhail AO, Padanilum TG, et al. Anatomic considerations for a modified posterior approach to the scapula. Clin Orthop Relat Res, 1997, (334):136-143.
15.	Ebraheim NA, Xu R, Haman SP, et al. Quantitative anatomy of the scapula. Am J Orthop (Belle Mead NJ), 2000, 29(4):287-292.
16.	Gauger EM, Cole PA. Surgical technique:a minimally invasive approach to scapula neck and body fractures. Clin Orthop Relat Res, 2011, 469(12):3390-3399.
17.	Anavian J, Conflitti JM, Khanna G, et al. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res, 2011, 469(12):3371-3378.
18.	Bozkurt M, Can F, Kirdemir G, et al. Conscrvative treatment of scapular neck fracture:the effect of stability and glenopolar angle on clinical outcome. Injury, 2005, 36(10):1176-1181.

1. Lapner PC, Uhthoff HK, Papp S. Scapula fractures. Orthop Clin North Am, 2008, 39(4):459-474.
2. Bahk MS, Kuhn JE, Galatz LM, et al. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. J Bone Joint Surg (Am), 2009, 91(10):2492-2510.
3. Miller ME, Ada JR. Injurie to the shoulder girdle//Browner BD, Levinen AM, Jupiter JB. Skeletal Trauma. 2nd ed. Philadephia:WB Saunder, 1998:1657-1670.
4. Harvey E, Audigé L, Herscovici D Jr, et al. Development and validation of the new international classification for scapula fractures. J Orthop Trauma, 2012, 26(6):364-369.
5. Rowe CR. Evaluation of the shoulder//Rowe CR. The shoulder. New York:Churchill Livingstone, 1988:631-637.
6. Dimitroulias A, Molinero KG, Krenk DE, et al. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res, 2011, 469(5):1459-1465.
7. Schofer MD, Sehrt AC, Timmesfeld N, et al. Fractures of the scapula:long-term results after conservative treatment. Arch Orthop Trauma Surg, 2009, 129(11):1511-1519.
8. van Noort A, van Kampen A. Fractures of the scapula surgical neck:outcome after conservative treatment in 13 cases. Arch Orthop Trauma Surg, 2005, 125(10):696-700.
9. Anavian J, Gauger EM, Schroder LK, et al. Surgical and functional outcomes after operative management of complex and displaced intrsarticular glenoid fractures. J Bone Joint Surg (Am), 2012, 94(7):645-653.
10. Schandelmaier P, Blauth M, Schneider C, et al. Fractures of the glenoid treated by operation. J Bone Joint Surg (Br), 2002, 84(2):173-177.
11. Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg, 2012, 20(3):130-141.
12. Lantry JM, Roberts CS, Giannoudis PV. Operative treatment of scapula fractures:a systematic review. Injury, 2008, 39(3):271-283.
13. Cole PA, Talbot M, Schroder LK, et al. Extra-articular malunions of the scapula:a comparison of functional outcome before and after reconstruction. J Orthop Trauma, 2011, 25(11):649-656.
14. Ebraheim NA, Mekhail AO, Padanilum TG, et al. Anatomic considerations for a modified posterior approach to the scapula. Clin Orthop Relat Res, 1997, (334):136-143.
15. Ebraheim NA, Xu R, Haman SP, et al. Quantitative anatomy of the scapula. Am J Orthop (Belle Mead NJ), 2000, 29(4):287-292.
16. Gauger EM, Cole PA. Surgical technique:a minimally invasive approach to scapula neck and body fractures. Clin Orthop Relat Res, 2011, 469(12):3390-3399.
17. Anavian J, Conflitti JM, Khanna G, et al. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res, 2011, 469(12):3371-3378.
18. Bozkurt M, Can F, Kirdemir G, et al. Conscrvative treatment of scapular neck fracture:the effect of stability and glenopolar angle on clinical outcome. Injury, 2005, 36(10):1176-1181.

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