PURPOSE: Fractures of the scapular, or glenoid, neck are strongly debated in the relevant literature. Analysis of the respective studies, however, revealed a considerable confusion in terms of definition, terminology and diagnosis. In addition, there are few studies, primarily case reviews, dealing in detail with these fractures. The aim of this article is to present detailed information about fractures of the scapular neck, based on the analysis of our own experience and of the published literature. MATERIAL AND METHODS: Our group of 17 fractures of the scapular neck comprised 14 men and three women, with a mean age of 38 years (range, 24-55). The authors diagnosed four fractures of the anatomical neck, nine fractures of the surgical neck and five trans-spinous fractures of the neck. Of these 17 scapular neck fractures, six fractures were treated non-operatively, and 11 fractures were operated on via the posterior Judet approach. The mean follow-up was 4.9 years (range, 1-11). RESULTS: Fractures in all six non-operatively treated patients healed without complications in the anatomical position and with full function of the shoulder. In 11 operatively treated patients, all fractures of the scapula and clavicle healed within three months. In nine cases the function of the shoulder was subjectively and objectively assessed as normal, and in the remaining two cases as fair. CONCLUSION: The term "scapular, or glenoid, neck" covers three different types of fractures, i.e., fracture of the anatomical neck, fracture of the surgical neck and trans-spinous neck fracture. Fractures of the surgical neck are divided into stable, fractures with rotational instability and fully unstable fractures, depending on the integrity of the coracocacromial and coracoclavicular ligaments. Accurate diagnosis of fractures of the scapular neck requires 3D CT reconstructions. Undisplaced or minimally displaced fractures may be treated non-operatively, markedly displaced fractures constitute an indication for osteosynthesis via the Judet approach.
- MeSH
- dospělí MeSH
- fraktury kostí * klasifikace diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka anatomie a histologie zranění radiografie MeSH
- mladý dospělý MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Epithelioid and epithelial neoplasms of bone are rare. They include different epithelioid variants of vascular lesions, osteoblastoma, chondroblastoma and most importantly metastatic carcinoma. Up to now, only few cases of epithelioid osteosarcoma were described. In this case the authors report a 53-year-old patient presented with a medical history of chronic shoulder pain for 3 years. Magnetic resonance imaging (MRI and computed tomography (CT) showed a destructive, partially calcified osseous lesion of the scapula with expansion into the surrounding soft tissue, suggestive of a primary bone tumor. Histologically, the tumor consisted of epithelioid cells with expression of cytokeratine and the lesion was primarily diagnosed as metastatic carcinoma. With regard to the MRI morphology untypical for metastatic disease the histopathologic slides were re-evaluated and detection of tumor osteoid led to the diagnosis of epithelioid osteosarcoma. Chemotherapy was initiated, however follow-up imaging studies showed rapidly progressive disease of both primary tumor and lung metastases. In conclusion, epithelioid neoplasms of the bone are extremetumourly rare and must be distinguished from metastatic carcinoma. Despite the presence of cytokeratine positive cells a thorough histological evaluation is mandatory and osteoid detection is essential in order to establish the correct diagnosis and further treatment. Key words: osteosarcoma, epithelioid, aneurysmal bone cyst, chondrosarcoma, pathology, immunohistochemistry.
- MeSH
- aneurysmatické kostní cysty diagnóza patologie MeSH
- biopsie MeSH
- bolest ramene etiologie MeSH
- chybná diagnóza MeSH
- diferenciální diagnóza MeSH
- imunohistochemie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka patologie radiografie MeSH
- magnetická rezonanční tomografie MeSH
- nádory kostí komplikace diagnóza patologie MeSH
- nádory páteře sekundární MeSH
- nádory plic sekundární MeSH
- osteosarkom komplikace diagnóza patologie sekundární MeSH
- poranění paže komplikace MeSH
- zhmoždění komplikace diagnóza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Anatomical neck fractures of the scapula are rare. The authors have found in the literature only four radiologically documented fractures of the anatomical neck of the scapula. Two of them were published by Hardegger et al., the third case was published by Arts and Louette. The last case, in fact only a radiograph and a rather poor 3D CT reconstruction of a fracture of the anatomical neck of scapula, was published by Jeong and Zuckerman. Together with author's two patients, the group of radiologically verified anatomical neck fractures of the scapula comprises six cases in total (four men, one woman, one gender unspecified). Analysis of the radiographs showed that in all these cases, the fracture line separated only the glenoid fossa from the scapular body, with a short spike of the lateral border of the scapula. The proximal part of the vertical fracture line ran into the coracoglenoid notch, between the upper border of the glenoid and the base of the coracoid process. The distal part of the fracture line crossed the lateral border of the scapular body 2-4 cm distal to the inferior pole of the glenoid fossa. The gleniod fragment was always formed by the glenoid fossa and a short spike of the lateral border of the scapular body. In five cases, the glenoid fragment, together with the humeral head, was displaced distally and the humeral head came to lie below the level of the coracoid process. At the same time, the glenoid fragment rotated into a valgus position. Only in one case, did the radiographs fail to show valgus displacement and the fracture was angulated in the transverse plane. In all six cases, the subacromial space between the acromion and the humeral head was widened. All fractures were operated on via a Judet posterior approach. In five cases, the outcome of the operation was assessed at 3, 5, 12, 21 and 120 months after surgery, three-being rated as excellent or very good, one as good and one as poor.
- MeSH
- fraktury kostí * radiografie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka zranění radiografie chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
PURPOSE: Bilateral scapular fracture is a very rare injury. Most of these fractures result from electrical shock or epileptic seizure. We treated six patients with such injuries, all of them caused by direct violence. The aim of this study was to report on the patients and to present an overview of the cases published so far. METHODS: Between January 2011 and August 2012, we treated six patients with bilateral scapular fractures (four men and two women, age range 20-78 years). Another 11 cases were found in the literature. All cases were analysed in terms of injury mechanism, fracture pattern and the manner of diagnosis. RESULTS: Our six patients increased the total number of recorded cases to 17 and the number of patients with traumatic bilateral scapular fractures from four to ten. In five of our cases, the injuries were classified as being the result of high-energy trauma. Computed tomography (CT) examination of the affected scapulae was performed in all six cases, in five in combination with 3D CT reconstruction; in one polytraumatised female patient, only axial CT scans were obtained. In all five high-energy trauma cases, bilateral fracture of the scapular body was recorded, of which one was classified as open. Four of the 11 cases found in the literature were caused by direct violence: in six patients, the fractures resulted from muscle spasms associated with epileptiform seizure or electrical shock, and one patient suffered a pathological fracture associated with amyloidosis. The most frequently recorded fracture in all 17 patients (34 fractures) was of the scapular body, i.e. 24 fractures, followed by 12 fractures of the glenoid fossa. CONCLUSION: According to data in the literature, bilateral scapular fracture is a rare injury. One reason may be that the potential incidence is often neglected. With the increasing number of patients with polytrauma, the potential for scapular fracture should always be taken into account, together with the fact that this injury may be bilateral. Of vital importance in diagnosing these injuries is CT scanning, including 3D CT reconstructions.
- MeSH
- dospělí MeSH
- fraktury kostí epidemiologie etiologie radiografie MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka zranění radiografie MeSH
- počítačová rentgenová tomografie MeSH
- rány a poranění komplikace MeSH
- retrospektivní studie MeSH
- senioři MeSH
- spasmus komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Historie léčby zlomenin lopatky je těsně spjata s dějinami francouzské chirurgie. Paré, Petit, Du Verney, Desault a Malgaigne jako první upozornili na existenci těchto zlomenin. Mayo Robson v r. 1884, Lambotte v r. 1910, Lane v r. 1914 a později Robert Judet byli pionýry operační léčby. Na ně mnohem následně navázala AO/ASIF, která přispěla zdokonalením metod osteosyntézy. Současné studie pomáhají upřesnit indikační kritéria k operační léčbě extraartikulárních zlomenin těla a krčku lopatky, která dosud nejsou jednotná.
The history of treatment of scapula fractures is closely connected with the history of French surgery. Paré, Petit, Du Verney, Desault and Malgaigne were the first to point out the existence of these fractures. Mayo Robson in 1884, Lambotte in 1910, Lane in 1914, and later Robert Judet were the pioneers of operative treatment. Subsequently, their concepts were used by AO/ASIF which improved the methods of internal fixation of these fractures. Current studies focus upon the specification of indication criteria of operative treatment of extra-articular fractures of the scapular body and neck that, however, have not been unified as yet.
- Klíčová slova
- zlomeniny lopatky,
- MeSH
- dějiny 16. století MeSH
- dějiny 17. století MeSH
- dějiny 18. století MeSH
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- fixace fraktur dějiny metody trendy MeSH
- fraktury kostí dějiny radiografie terapie MeSH
- lidé MeSH
- lopatka radiografie zranění MeSH
- významné osobnosti MeSH
- Check Tag
- dějiny 16. století MeSH
- dějiny 17. století MeSH
- dějiny 18. století MeSH
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- lidé MeSH
- Publikační typ
- historické články MeSH
- Geografické názvy
- Francie MeSH
The authors operated on 22 patients with scapular body fractures, with a mean age of 35 years. The minimal follow-up was 12 months. All patients were treated from the Judet posterior approach. The study included 14 cases of an isolated body fracture, three of scapular body fracture combined with fracture of the scapular neck and five of glenoid fossa fracture. In all 14 cases where a 3D computed tomography (CT) reconstruction was performed prior to operation, intraoperative findings corresponded to this reconstruction. In eight cases without preoperative 3D CT reconstruction, the correct type of fracture was identified in only two cases. We also identified three basic types of fractures of the lateral border of the scapula. The anatomical relationship between the glenoid fossa and scapular body, congruency and stability of the shoulder joint was achieved in all cases. The average constant score was 94.
- MeSH
- dospělí MeSH
- fraktury kostí radiografie chirurgie MeSH
- interní fixátory MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka zranění radiografie chirurgie MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie MeSH
- pooperační komplikace MeSH
- ramenní kloub zranění patofyziologie chirurgie MeSH
- rozsah kloubních pohybů MeSH
- úrazy a nehody MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Cílem práce bylo studium kostní architektoniky lopatky a její význam pro průběh lomných linií u zlomenin těla lopatky. Metoda a materiál: Architektonika lopatky byla studována na 100 suchých kostěných preparátech dospělých lopatek. Zjištěná fakta byla porovnávána s průběhem lomných linií u 22 pacientů operovaných pro zlomeninu těla lopatky. Výsledky: Základní konstrukci anatomického těla lopatky představoval trojúhelník ohraničený bází spina scapulae, mediálním a laterálním okrajem fossa infraspinata. Spinální a laterální okraj tohoto “biomechanického” trojúhelníka tvořily dva silné pilíře procházející krčkem lopatky a končící ve střední a dolní části glenoidu. Angulus superior s přilehlou částí fossa supraspinata představoval appendix zmíněného biomechanického trojúhelníka. Nejslabší místo celé jeho konstrukce tvořilo spojení mediálního a spinozního okraje, tzv. spino-mediální úhel. Zeslabené místo bylo zjištěno i v centrální části spina scapulae. Distribuce lomných linií prokázala dvě kritické oblasti. První byla horní část margo lateralis, druhou spino-mediální úhel. U většiny zlomenin těla lopatky vycházela primární lomná linie z horní poloviny margo lateralis a směřovala mediálně do spino-mediálního úhlu. Diskuze: Naše anatomické nálezy korespondovaly s nálezy klinickými i s literárními údaji. Koncepci biomechanického trojúhelníka podporuje i fakt, že tlakové síly jsou přenášeny na tělo lopatky tzv. spinálním a laterálním pilířem, tedy do dvou nejsilnějších stran biomechanického trojúhelníku. Závěr: Je třeba nutné rozlišit anatomické a biomechanické tělo lopatky a jako zlomeniny těla lopatky označovat pouze zlomeniny biomechanického těla.
Background: A study of the scapular osseous architecture and its impact on the distribution of fracture lines of its body fractures. Methods and material: The osseous architecture of the scapula was studied on 100 dry specimens of adult human scapulae. The findings were compared with the distribution of fracture lines in 22 patients, operated on the scapular body fracture. Results: The basic structure of the anatomical body of the scapula was a triangle demarcated by the spine of scapula base, the medial and lateral borders of the infraspinous fossa. The spinal and lateral borders of this “biomechanical” triangle were formed by two strong pillars extending through the scapular neck as far as the middle and lower part of the glenoid. The superior angle of scapula with the adjacent part of the supraspinous fossa formed an appendix of the mentioned biomechanical triangle. The weakest part of its whole structure was the junction of the medial and spinous border, so called spino-medial angle. Another weak part was identified in the central section of the spine of the scapula. Distribution of fracture lines showed two critical areas. The first was the upper part of the lateral border and the second one was the spino-medial angle. In most fractures of the scapula body the primary fracture line came out from the upper half of the lateral border medially up to the spino-medial angle. Discussion: Our anatomical findings coincided with both clinical data and information published in medical literature. The concept of the biomechanical triangle is supported also by the fact that the compression forces are distributed to the scapular body by so called spinal and lateral pillars, i.e. the two strongest sides of the biomechanical triangle. Conclusions: It is necessary to distinguish between the anatomical and the biomechanical body of the scapula. Only fractures of the biomechanical body may be considered fractures of the scapular body.
- MeSH
- antropometrie MeSH
- dospělí MeSH
- fraktury kostí MeSH
- lidé MeSH
- lopatka anatomie a histologie radiografie zranění MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
The history of treatment of scapula fractures is closely connected with the history of the French surgery. Paré (Les œuvres d´Ambroise Paré, conseiller, et premier chirurgien du Roy, Gabriel Buon, Paris, p VCV, 1579), Petit (Traité des maladies des os. Tome second, Charles-Etienne Hochereau, Paris, pp 122–138, 1723), Du Verney (Traité des maladies des os. Tome I, de Burre, Paris, pp 220–231, 1751) and Desault (Œuvres chirurgicales, ou tableau de la doctrine et de la pratique dans le traitement des maladies externes par Xav. Bichat, Desault, Méquignon, Devilliers, Deroi, Paris, pp 98–106, 1798) were the first to point out the existence of these fractures. The first drawing of a scapula fracture was presented by Vogt (Dissertatio de ambarum scapularum dextroeque simul claviculae fractura rara, Dissertatione Universitae Vitembergensi, Wittenberg, 1799). This author was also the first to describe the scapula fracture associated with ipsilateral fracture of the clavicle. The first radiograph of scapula fracture (glenoid fossa fracture) was published by Struthers (Edinburgh Med J 4(3):147–149, 1910). The first internal fixation of scapula fracture using plate was done by Lambotte (1910) who was followed by Lane (The operative treatment of fractures, Medical Publishing Co, London, pp 99–101, 1914) and later by Lenormant (Sur l´ostéosynthèse dans certains fractures de l´omoplate Bulletins et mémoires de la Société de chirgie de Paris, pp 1501–1502, 1923), Dujarier (Fracture du col chirgical de l´omoplate. Ostéosynthèse par plaque en T. Bonne réduction. Bulletin et mémoires de la Société de chirurgie de Paris, pp 1492–1493, 1923) and Basset (Ostéosynthèse d´une fracture de l´omoplate. Bulletin et mémoires de la Société nationale de chirurgie. p 193, 1924). Dupont and Evrard (J Chir (Paris) 39:528–534, 1932) presented the first detailed description of the surgical approach along the lateral border of the scapula including two drawings. They were also the first to use the term “pillar of scapula”. Judet (Acta Orthop Belg 30:673–678, 1964) advocated operative treatment of displaced scapula fractures and described extensile posterior approach. Based on the French school, AO/ASIF improved methods of internal fixation of these fractures.
- MeSH
- dějiny 16. století MeSH
- dějiny 17. století MeSH
- dějiny 18. století MeSH
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- fixace fraktur dějiny metody MeSH
- fraktury kostí dějiny radiografie terapie MeSH
- lidé MeSH
- lopatka zranění radiografie MeSH
- obvazy dějiny MeSH
- učebnice jako téma dějiny MeSH
- Check Tag
- dějiny 16. století MeSH
- dějiny 17. století MeSH
- dějiny 18. století MeSH
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- historické články MeSH
- Geografické názvy
- Francie MeSH
Izolované zlomeniny lopatky sú relatívne zriedkavé ochorenia, oveľa častejšie sa vyskytujú s ďalšími asociovanými poraneniami. Izolovaná volárne dislokovaná zlomenina lopatky u dieťaťa s dislokáciou imitujúcou scapular winging je ešte zriedkavejšia. Prezentujeme prípad zlomeniny tela lopatky, ktorú sme riešili konzervatívne, ale vzhľadom na riziko zostatkovej deformity, eventuálne obmedzenia hybnosti ramenného zhybu sme previedli krytú repozíciu zlomeniny.
Isolated scapular fractures are relatively uncommon injuries, the are often associated with other injuries. Isolated volarly displaced scapular fracture in a child with dislocation, which mimic scapular winging, is much more seldom. We present a case of child with above mentioned scapular fracture, which was treated non operatively. Dislocation was reduced in effort to reduce risk of constricted motion in shoulder due to dislocation.
- MeSH
- dítě MeSH
- fraktury kostí radiografie terapie MeSH
- lidé MeSH
- lopatka radiografie zranění MeSH
- lyžování zranění MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
