BACKGROUND: The acromion projects laterally in a curving orientation. When a fracture of the acromion occurs, despite being rare, matching the best-fit fixation plate is challenging due to few options and limited availability of fixation plate types. Alternative fixation methods can carry risk of nonunion complications. PURPOSE: The objective of this study was to investigate the morphological curvature pattern of the acromion to assess the level of the fixation plates fitness and provide the suitable imaging modalities for evaluating the acromion curvature. BASIC PROCEDURES: The correlation between the acromion curvature and five fixation plates were calculated and their fitness level was evaluated statistically. The curvature of acromion and the five available fixation plates were photographed and assessed digitally by software (FIJI ImageJ and Microsoft Excel). The method entails plotting seven points along the curving surface and margins of the acromion, while the Excel Solver function calculates the regression, ultimately giving curvature values. First, the acromion parameters were studied on 180 paired healthy dry scapulae. Then, the acromion curvature values were compared to the fixation plates curvatures. Likewise, the acromion curvature was assessed as applicable on 153 (100 AP- views, 50 Y- views, and 3 superior-views) retrospective plain X-rays and 40 3D-CT scapula reconstructions of healthy acromia. MAIN FINDINGS: The mean length of the acromion was 48.70 ± 5.29 mm, mean thickness was 8.51 ± 1.67 mm, and mean width was 25.97 ± 5.97 mm. The calculated values of the mean curvatures were 0.050 ± 0.015 mm-1 for the mean acromion surface, 0.042 ± 0.027 mm-1 for the internal margin, and 0.055 ± 0.010 mm-1 for the external margin. The curved geometry of the acromion was plotted on a graph giving a spectrum of curvature patterns with distribution values revealing fixation plates fitness represented by area under the curve with frequencies of 4.32 % for the acromion-specific fixation plate, 14.28 % for the large clavicle fixation plate, 0.26 % for the small clavicle fixation plate, 53.38 % for the flexible universal fixation plate, and none for the rigid universal fixation plate. PRINCIPAL CONCLUSIONS: Approximately 27.76 % of the acromion surface curvatures distribution does not overlap with any of our measured fixation plates. Evaluating the acromion surface curvature was possible on plain X-rays in the Y-view only.
- MeSH
- Acromion * diagnostic imaging injuries anatomy & histology surgery MeSH
- Fractures, Bone * surgery diagnostic imaging MeSH
- Bone Plates * MeSH
- Humans MeSH
- Scapula * diagnostic imaging anatomy & histology MeSH
- Radiography MeSH
- Fracture Fixation, Internal * methods instrumentation MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: The scapular structures that have not yet been assigned anatomic terms generate a challenge in clinical diagnostics and surgical application, as well as in scientific observation. The aim of this study was to solve the lack in terminology concerning the scapula and the scapular region. METHODS: Observation and description of 29 structures were carried out on both dry scapulae and radiographs of the shoulder joint. In addition, several terms commonly encountered throughout the literature concerning the scapula were revised. A degree of consensus was reached by using the Delphi method surveying the opinions of 21 invited experts in the field. Taxonomy panels and etymology of anatomic terminology were considered in the generation of the proposed terms. RESULTS: The scapula was redefined as a lamina with projecting processes, and several landmarks demarcating certain newly defined topographic spaces were highlighted via 2 rounds of Delphi systematic voting and discussion. The overall level of the peer nominees' consensus was high. Few terms received a neutral opinion. CONCLUSIONS: This study communicates a proposal of 16 new terms defining grossly visible structures on the scapula that have not yet been described by officially recognized terms, including a call to unify 13 previously contributed terms that have not been codified and are often used interchangeably within different surgical and scientific fields. Incorporating these terms into the anatomic nomenclature would facilitate communication accuracy and eliminate ambiguity among clinicians, surgeons, and anatomists.
- MeSH
- Consensus MeSH
- Humans MeSH
- Scapula * diagnostic imaging MeSH
- Shoulder Joint * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Úvod: Poraněním AC kloubu u zlomenin lopatky se detailně dosud nikdo nezabýval. Cílem této studie je proto popsat pathoanatomii těchto poranění. Metody: V souboru 519 zlomenin lopatky u dospělých pacientů vzniklém v období 2002−2020 jsme identifikovali celkem 20 (3,9 %) případů spojených s AC luxací. Jednalo se o 17 mužů a 3 ženy průměrného věku 49 roků (21−78). U všech pacientů byl proveden rtg snímek ramenního kloubu a následně CT vyšetření včetně 3D rekonstrukcí. Tato obrazová dokumentace umožnila hodnocení typu zlomeniny lopatky a typu poranění AC kloubu. Výsledky: V 15 případech byla AC luxace spojena pouze s jednoduchou zlomeninou lopatky (7x zlomenina báze proc. coracoideus, 4x zlomenina akromia nebo laterální spiny, 2krát zlomenina těla lopatky, 1x zlomenina horního glenoidu a 1x zlomenina dolního glenoidu). V 5 případech se jednalo o vícečetné nebo komplexní zlomeniny lopatky (1x kombinace zlomeniny proc. coracoideus a laterální části spina scapulae, v 1 případě kombinace zlomeniny horního glenoidu a akromia, ve 2 případech komplexní intraartikulární zlomenina a v 1 případě skapulotorakální disociace). Závěr: AC luxace je méně častým poraněním doprovázejícím zlomeniny lopatky. Nejčastěji se vyskytuje u zlomenin proc. coracoideus, akromia/ laterální spiny nebo horního glenoidu. Nebyla zaznamenána u zlomenin krčku lopatky.
Introduction: No detailed study dealing with an injury to the AC joint in combination with scapular fractures has been published to date. The aim of this study is to describe pathoanatomy of these injuries. Methods: In a series of 519 scapular fractures in adult patients from the period of 2002−2020 we identified a total of 20 (3.9%) cases associated with AC dislocation. The group comprised 17 men and 3 women with the mean age of 49 years (range, 21−78). Radiographs of the shoulder joint followed by CT examination, including 3D reconstructions, were performed in all patients. This documentation allowed assessment of the scapular fracture pattern and type of injury to the AC joint. Results: AC dislocation was associated with a simple scapular fracture in 15 cases (7 fractures of the coracoid base, 4 fractures of the acromion or the lateral spine, 2 fractures of the scapular body, 1 fracture of the superior and 1 fracture of the inferior glenoid). In 5 cases AC dislocation accompanied multiple or complex scapular fractures (once a combination of a coracoid fracture and a fracture of the lateral scapular spine, once a combination of a fracture of the superior glenoid and of the acromion, 2 cases of a complex intraarticular fracture and 1 case of scapulothoracic dissociation). Conclusion: AC dislocation is relatively infrequent injury accompanying scapular fractures. It is most commonly associated with fractures of coracoid, acromion/lateral spine or superior glenoid. No case of AC dislocation was recorded in a fracture of the scapular neck.
- MeSH
- Humans MeSH
- Scapula diagnostic imaging MeSH
- Magnetic Resonance Imaging MeSH
- Nerve Compression Syndromes * diagnostic imaging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
- Comment MeSH
- Research Support, Non-U.S. Gov't MeSH
Tříletá fena boerboela byla předvedena pro 3 týdny trvající intermitentní kulhání na pravou hrudní končetinu. Přesná lokalizace nebyla klinickým vyšetřením možná. Screeningové rentgenové vyšetření odhalilo abnormality kostního podkladu glenoidu pravé lopatky (miskovité části) a volný plyn v kloubní štěrbině. Pomocí počítačové tomografie byla jako hlavní nález zjištěna osteochondróza kaudálního glenoidu lopatky. Terapií volby bylo artroskopické ošetření léze. Tři měsíce po zákroku majitelka hodnotila výsledek léčby jako dobrý.
A 3-year-old female boerboel dog was presented for 3 weeks lasting intermittent limping on right front leg. Physical examination was without specific findings. Screening X-ray examination revealed abnormality of the right glenoid of scapula and free gas in joint space. The main finding of CT study was osteochondrosis of the caudal glenoid of the right scapula. The lesion was treated by arthroscopic surgery. The owner claimed good outcome 3 months after surgery.
- MeSH
- Arthroscopy veterinary MeSH
- Scapula * surgery diagnostic imaging pathology MeSH
- Osteochondrosis * surgery diagnostic imaging pathology veterinary MeSH
- Tomography, X-Ray Computed veterinary MeSH
- Dogs MeSH
- Shoulder Joint surgery diagnostic imaging pathology MeSH
- Lameness, Animal surgery pathology MeSH
- Imaging, Three-Dimensional veterinary MeSH
- Animals MeSH
- Check Tag
- Dogs MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Case Reports MeSH
INTRODUCTION: The superior surface of the anatomical neck is presented in the classification of scapular fractures as a 2-cm-long structure, which does not correspond to reality. This issue has not yet been adequately addressed in the literature. The aim of the study was to assess the variability of a notch between the upper rim of the glenoid and the coracoid base, the so-called coracoglenoid notch (CGN), and its clinical significance. MATERIALS AND METHODS: The study was based on the examination of 204 dry bone specimens of adult scapulae (92 male and 112 female). We have determined quantitative criteria for the evaluation of the CGN type, measuring the offset of anatomical neck using a digital caliper. The findings were compared with 3D CT reconstructions of fractures of the scapular anatomical neck. RESULTS: Three basic types of CGN have been identified: type A-a well-developed notch in 31%, type B-a shallow notch in 53% and type C-an absent notch in 16%. No significant difference in CGN was found between the sexes, or between the right and left sides. When compared with our six cases of the anatomical neck fracture of the scapula, two patients displayed CGN type A and type B, respectively; but in four patients, it was impossible to distinguish between types A and B. CONCLUSION: The study has documented a high variability of CGN. Its presentation in the classification schemes does not correspond to anatomical reality. The presence of a deep, or shallow, notch may constitute an anatomical predisposition to a fracture of the anatomical neck.
- MeSH
- Anatomic Variation MeSH
- Adult MeSH
- Fractures, Bone diagnostic imaging etiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Scapula anatomy & histology diagnostic imaging injuries MeSH
- Adolescent MeSH
- Young Adult MeSH
- Tomography, X-Ray Computed MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE: Until now, classifications of coracoid fractures have been based on plain radiographs, without use of 3D CT reconstructions. Therefore, the aim of the present study has been to describe the pathoanatomy of these fractures and their associated injuries to the shoulder girdle, on the basis of 3D CT reconstructions. METHODS: The cohort comprised 39 patients, who each sustained a coracoid fracture investigated with 3D CT reconstructions. The patients were assessed in terms of age, gender, pathoanatomy of the coracoid fracture, fractures of other parts of the scapula, and associated injuries to the shoulder girdle. RESULTS: We identified 24 fractures of the base, one fracture of the beak body, eight fractures of the apex, and six comminuted fractures of the coracoid process. A total of 22 associated injuries were found (7 fractures of the acromion, 5 fractures of the anterior glenoid rim, 3 fractures of the superior glenoid, 1 fracture of the inferior glenoid, 4 fractures of the surgical neck, 2 fractures of the scapular body) and 18 other associated injuries to the shoulder girdle (8 AC dislocations, 5 proximal humeral fractures, and 5 clavicular fractures). CONCLUSION: On the basis of 3D CT reconstructions, four basic coracoid fracture patterns were identified. The authors´ findings and literature review have shown that a considerable number of coracoid fractures are combined with injuries to other parts of scapula and shoulder girdle. These associated injuries must be taken into account and targeted when taking the patient's history, and during clinical and primarily radiological examinations.
PURPOSE OF THE STUDY Fractures of the scapula are less frequent, with the incidence reported in literature of approximately 1% of all fractures and 3-5% fractures of shoulder. These fractures are predominantly treated non-operatively. Osteosynthesis is indicated in displaced intra-articular fractures and severely displaced extra-articular fractures of the scapular body, its lateral border in particular. Apart from open reposition and osteosynthesis, also minimally invasive osteosynthesis under fluoroscopic and arthroscopic control has recently been used to treat intra-articular fractures of the scapula. The arthroscopy facilitates debridement of the fracture line in the intra-articular region and control over the insertion of the osteosynthesis material in the subchondral bone of the glenoid and it also makes visible the accuracy of reduction of fractures of the glenoid articular surface. MATERIAL AND METHODS In 2013-2017, osteosyntheses of 9 intra-articular fractures of the scapula were performed with the use of both perioperative fluoroscopy and arthroscopy. The group included 7 men and 2 women, with the mean age of 37 years (range 24-52 years). 4.5 mm cannulated screws inserted in the subchondral bone either from the cranial or dorso-caudal part of the glenoid in dependence on the type of the fracture were used as osteosynthesis material. Postoperatively, the extremity was fixed by Desault type shoulder brace for 4 weeks. Rehabilitation using standard procedures for shoulder joint followed. The patients were followed up at regular intervals, namely on 10th day, at 4 weeks, 3, 6, 12 and 24 months postoperatively. The clinical outcomes and radiologic signs of healing were evaluated continuously and two years after the surgery the clinical outcomes were assessed using the Constant score. Arm elevation was assessed separately, as a dominant indicator of shoulder joint function. RESULTS No perioperative complications were reported, the operative times ranged from 45 to 120 minutes. Reduction was always performed in fractures with intra-articular displacement of less than 2 mm, which was measured both arthroscopically and on perioperative and postoperative radiographs. No complications of wound healing were observed. One patient experienced temporary paresthesia in the innervation zone of the sensitive branch of the radial nerve. The mean healing time of fractures was 121 days (range 107-146 days). The mean Constant score at two years after surgery was 83 points (range 78-87 points), the resulting restriction of elevation was 12° on average (range 0-23°). DISCUSSION There are not many papers covering a similar topic in world literature, most of them present the benefits of arthroscopy in some types of osteosyntheses of intra-articular fractures of the scapula. Most frequently mentioned are osteosyntheses of the anterior portion of the glenoid in case of a bony Bankart lesion. These papers highlight the benefits of minimal invasiveness of this procedure. CONCLUSIONS By visualising the fracture line, the arthroscopy facilitates a more accurate reduction of fragments and a minimally invasive osteosynthesis of some intra-articular fractures of the scapula when compared to closed reduction with fluoroscopic intraoperative control only. The use of arthroscopy in these interventions is conditional on perfect mastering of the surgical technique and also the use of special instruments both for arthroscopy and minimally invasive osteosynthesis. If these criteria are observed and the surgical technique mastered, the authors consider this method beneficial in treating the glenoid fractures. Key words: minimally invasive osteosynthesis, glenoid fractures.
- MeSH
- Arthroscopy MeSH
- Adult MeSH
- Shoulder Fractures * MeSH
- Intra-Articular Fractures * MeSH
- Middle Aged MeSH
- Humans MeSH
- Scapula diagnostic imaging surgery MeSH
- Young Adult MeSH
- Fracture Fixation, Internal MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Superior Shoulder Suspensory Complex (SSSC) is a bone and soft-tissue ring securing the connection of the upper extremity to the axial skeleton via the clavicle and sternoclavicular joint. An isolated injury to one component of SSSC is usually stable. An injury to 2 of its components is a potential source of shoulder girdle instability and requires surgical stabilisation. An injury affecting 3 and more components is extremely rare and surgical stabilisation should be indicated. Our study presents the case of a 50-year-old man who fell off the bicycle and sustained a direct blow to his left shoulder resulting in an ipsilateral fracture of the coracoid and acromion process combined with the fracture of the distal end of the clavicle. Following a standard clinical examination and a subsequent X-ray and a CT scan with three-dimensional shoulder reconstruction, an open reduction and stabilisation of all the injured SSSC components was performed. Later, early and gradual rehabilitation of the shoulder girdle was commenced. At 48 weeks after the surgery, almost full range of motion of the shoulder joint was achieved and the muscle strength of the operated upper extremity was comparable to that of the healthy one. Key words:Superior Shoulder Suspensory Complex, fracture, acromion, coracoid process, clavicle.
- MeSH
- Acromion diagnostic imaging injuries MeSH
- Fractures, Bone diagnostic imaging rehabilitation surgery MeSH
- Clavicle diagnostic imaging injuries MeSH
- Middle Aged MeSH
- Humans MeSH
- Scapula diagnostic imaging injuries MeSH
- Shoulder Injuries diagnostic imaging rehabilitation surgery MeSH
- Coracoid Process diagnostic imaging injuries MeSH
- Fracture Fixation, Internal MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
V roce 1991 popsali Ada a Miller nový typ zlomeniny krčku lopatky. Jednalo se o transverzální zlomeninu těla lopatky probíhající od spodního okraje glenoidu těsně pod spina scapulae do mediálního okraje těla lopatky (jejich typ IIC). Tato zlomenina byla později přejmenována Gossem na “fracture of neck inferior to scapula spine“. Od té doby je tento typ zlomeniny příčinou řady nejasností, zejména v případě tzv. plovoucího ramena. Za zlomeniny krčku lopatky lze považovat pouze ty extraartikulární zlomeniny laterálního úhlu lopatky, které kompletně oddělují glenoid od těla lopatky. Termín „fracture of neck inferior to scapula spine“ tento popis nesplňuje, neboť neodděluje od těla lopatky glenoid, ale velký infraspinátní fragment. Jedná se tedy o příčnou dvou-fragmentovou zlomeninu infraspinátní části těla lopatky. Toto označení by nemělo být dále v literatuře používáno.
In 1991, Ada and Miller described a new type of scapular neck fracture. It was a transverse fracture of the scapular body passing from the inferior border of the glenoid to the medial border of the scapular body (their type IIC). This fracture was later designated by Goss as a “fracture of neck inferior to scapula spine“. Since then, this type of fracture has been the cause of a number of controversies, mainly concerning the so-called “floating shoulder”. However, scapular neck fractures can be considered to be only those fractures that separate completely the glenoid from the scapular body. Term “fracture of neck inferior to scapula spine“ does not fit into this definition because it does not compromise the junction between the glenoid fossa and the scapular body. Actually, it is a transverse two-part fracture of the infraspinous part of the scapular body. As a result this term should no longer be used in the literature.
- MeSH
- Fractures, Bone surgery classification MeSH
- Humans MeSH
- Scapula * anatomy & histology diagnostic imaging injuries MeSH
- Imaging, Three-Dimensional MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
