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Surgical Technique: A Minimally Invasive Approach to Scapula Neck and Body Fractures

  • Symposium: Fractures of the Shoulder Girdle
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The approach of choice for open reduction internal fixation of displaced fractures involving the scapula neck or body is from posterior. We describe a new approach that minimizes the surgical insult to the soft tissues but preserves the ability to restore alignment and stability to the fracture.

Description of Technique

Based on the fracture pattern, incisions are made along the anatomic bony perimeter to access the scapula borders for reduction and fixation. Since the incisions are centered over sites of “perimeter” fracture displacement of this relatively flat bone, minimal soft tissue retraction and less muscular stripping are necessary, while indirect reduction of the intervening scapula body is accomplished to restore anatomic alignment.

Patients and Methods

We retrospectively reviewed seven men with a mean age of 39 years (range, 19–75 years) who underwent open reduction internal fixation of a displaced scapula body or neck fracture using this minimally invasive approach. The minimum followup was 12 months (mean, 16 months; range, 12–23 months).

Results

Six of the seven patients returned to their original occupation/activities. The mean Disabilities of the Arm, Shoulder and Hand score at followup was 8.1 (range, 0–52; normative mean, 10.1). For all parameters, the mean SF-36 scores of the study patients were comparable to those of the normal population. Both strength and motion returned to equivalency with the uninjured shoulder. There were no intraoperative or postoperative complications.

Conclusions

This novel surgical approach to the scapula allows visualization of fracture reduction without an extensile incision or muscular or subcutaneous flaps and was associated with high functional scores.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Ada JR, Miller ME. Scapular fractures: analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–180.

    PubMed  Google Scholar 

  2. An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop. 2010;34:131–135.

    Article  PubMed  Google Scholar 

  3. Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, Cole PA. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am. 2009;91:2222–2228.

    Article  PubMed  Google Scholar 

  4. Braun C, Wirbel R, Mutschler W. The two-portal approach for internal fixation of scapular fractures. Eur J Trauma. 2005;31:186–193.

    Article  Google Scholar 

  5. Cole PA. Scapula fractures: open reduction internal fixation. In: Wiss DA, ed. Fractures. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:15–36.

  6. Corrales LA, Morshed S, Bhandari M, Miclau T 3rd. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008;90:1862–1868.

    Article  PubMed  Google Scholar 

  7. Ebraheim NA, Mekhail AO, Padanilum TG, Yeasting RA. Anatomic considerations for a modified posterior approach to the scapula. Clin Orthop Relat Res. 1997;334:136–143.

    PubMed  Google Scholar 

  8. Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Joint Surg Br. 1984;66:725–731.

    PubMed  CAS  Google Scholar 

  9. Hayes K, Walton JR, Szomor ZL, Murrell GA. Reliability of 3 methods for assessing shoulder strength. J Shoulder Elbow Surg. 2002;11:33–39.

    Article  PubMed  Google Scholar 

  10. Herrera DA, Anavian J, Tarkin IS, Armitage BA, Schroder LK, Cole PA. Delayed operative management of fractures of the scapula. J Bone Joint Surg Br. 2009;91:619–626.

    Article  PubMed  CAS  Google Scholar 

  11. Hsieh CY, Phillips RB. Reliability of manual muscle testing with a computerized dynamometer. J Manipulative Physiol Ther. 1990;13:72–82.

    PubMed  CAS  Google Scholar 

  12. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: The DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.

    Article  PubMed  CAS  Google Scholar 

  13. Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American Academy of Orthopaedic Surgeons Outcomes Instruments: normative values from the general population. J Bone Joint Surg Am. 2002;84:208–215.

    PubMed  Google Scholar 

  14. Imatani RJ. Fractures of the scapula: a review of 53 fractures. J Trauma. 1975;15:473–478.

    Article  PubMed  CAS  Google Scholar 

  15. Jerosch J, Greig M, Peuker ET, Filler TJ. The posterior subdeltoid approach: a modified access to the posterior glenohumeral joint. J Shoulder Elbow Surg. 2001;10:265–268.

    Article  PubMed  CAS  Google Scholar 

  16. Jones CB, Cornelius JP, Sietsema DL, Ringler JR, Endres TJ. Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures. J Orthop Trauma. 2009;23:558–564.

    Article  PubMed  Google Scholar 

  17. Judet R. Surgical treatment of scapular fractures. Acta Orthop Belg. 1964;30:673–678.

    PubMed  CAS  Google Scholar 

  18. Lantry JM, Roberts CS, Giannoudis PV. Operative treatment of scapular fractures: a systematic review. Injury. 2008;39:271–283.

    Article  PubMed  Google Scholar 

  19. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L. Fracture and Dislocation Classification Compendium - 2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J Orthop Trauma. 2007;10(Suppl):S1–S133.

    Article  Google Scholar 

  20. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa: results of open reduction and internal fixation. Clin Orthop Relat Res. 1998;347:122–130.

    Article  PubMed  Google Scholar 

  21. McGahan JP, Rab GT, Dublin A. Fractures of the scapula. J Trauma. 1980;20:880–883.

    Article  PubMed  CAS  Google Scholar 

  22. McGinnis M, Denton JR. Fractures of the scapula: a retrospective study of 40 fractured scapulae. J Trauma. 1989;29:1488–1493.

    Article  PubMed  CAS  Google Scholar 

  23. Nork SE, Barei DP, Gardner MJ, Schildhauer TA, Mayo KA, Benirschke SK. Surgical exposure and fixation of displaced Type IV, V, and VI glenoid fractures. J Orthop Trauma. 2008;22:487–493.

    Article  PubMed  Google Scholar 

  24. Norwood LA, Matiko JA, Terry GC. Posterior shoulder approach. Clin Orthop Relat Res. 1985;201:167–172.

    PubMed  Google Scholar 

  25. Obremskey WT, Lyman JR. A modified Judet approach to the scapula. J Orthop Trauma. 2004;18:696–699.

    Article  PubMed  Google Scholar 

  26. von Schroeder HP, Kuiper SD, Botte MJ. Osseous anatomy of the scapula. Clin Orthop Relat Res. 2001;383:131–139.

    Article  Google Scholar 

  27. Ware JE Jr, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston, MA: New England Medical Center, Health Assessment Lab; 1994.

    Google Scholar 

  28. Ware JE Jr, Sherbourne CD. The MOS 36-item Short-form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.

    Article  PubMed  Google Scholar 

  29. Whelan DB, Bhandari M, McKee MD, Guyatt GH, Kreder HJ, Stephen D, Schemitsch EH. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg Br. 2002;84:15–18.

    Article  PubMed  CAS  Google Scholar 

  30. Wiedemann E. [Fractures of the scapula] [in German]. Unfallchirurg. 2004;107:1124–1133.

    Article  PubMed  CAS  Google Scholar 

  31. Wijdicks CA, Armitage BM, Anavian J, Schroder LK, Cole PA. Vulnerable neurovasculature with a posterior approach to the scapula. Clin Orthop Relat Res. 2009;467:2011–2017.

    Article  PubMed  Google Scholar 

  32. Wirth MA, Butters KP, Rockwood CA Jr. The posterior deltoid-splitting approach to the shoulder. Clin Orthop Relat Res. 1993;296:92–98.

    PubMed  Google Scholar 

Download references

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter A. Cole MD.

Additional information

One or more of the authors (PAC) have received funding from Synthes, Inc (West Chester, PA). The funding source for this study did not play a role in the investigation.

Each author certifies that his institution has approved the human protocol for this investigation as required, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Gauger, E.M., Cole, P.A. Surgical Technique: A Minimally Invasive Approach to Scapula Neck and Body Fractures. Clin Orthop Relat Res 469, 3390–3399 (2011). https://doi.org/10.1007/s11999-011-1970-3

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  • DOI: https://doi.org/10.1007/s11999-011-1970-3

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