INTRODUCTION: A typical feature of inferior glenoid fractures is a distal fragment separated from the glenoid fossa. In most cases, the inferior glenoid fractures are associated with a fracture of the scapular body. However, there are no detailed studies of inferior glenoid fractures, and only brief mentions can be found in the literature in this respect. MATERIAL AND METHODS: The basic group comprised 42 patients, with the mean age of 48 years, who sustained 42 fractures of the inferior glenoid. In this group, the scapular fracture anatomy was evaluated, based on 3D CT reconstructions. A total of 29 patients operated on were followed up for 12 to 128 months after injury (average, 52 months), three patients were lost to follow up. The results of the operative treatment, including complications, were assessed radiologically and functionally. RESULTS: Fracture anatomy was described from various aspects, i.e., the size of the articular surface carried by the separated glenoid fragment, the existence of multiple articular fragments, the size of the separated glenoid fragment and the extent of injury to the scapular body. All 29 operatively treated fractures radiologically healed within three months. Full and pain-free range of motion was restored in 18 patients; in eight patients it was limited by 20 degrees and in three patients by more than 40 degrees. The mean Constant score was 82. CONCLUSION: Fractures of the inferior glenoid fossa requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment.

• MeSH
• Adult MeSH
• Shoulder Fractures diagnostic imaging   surgery   MeSH
• Glenoid Cavity diagnostic imaging   injuries   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Tomography, X-Ray Computed methods   MeSH
• Retrospective Studies MeSH
• Range of Motion, Articular MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Fracture Fixation, Internal adverse effects   methods   MeSH
• Imaging, Three-Dimensional methods   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: The aim of the article is to present the pathoanatomy and a new classification of glenoid fractures developed on the basis of analysis of 3D computed tomography (CT) examinations and intra-operative findings. MATERIALS AND METHODS: The study group comprised 90 patients (69 men and 21 women) who sustained glenoid fractures. Mean patient age was 47 years (17-92). In 77 nonpolytraumatised patients, anteroposterior (AP) radiographs of the affected shoulder girdle were taken, including Neer I and II views. All 90 patients underwent CT examination, combined in 73 of them with 3D CT reconstruction including subtraction of the humeral head, ribs and clavicle, from the anterior and posterolateral views. In total, 52 patients (58 %) were operated on and 38 42 %) were treated non-operatively. RESULTS: In total, five basic types of injuries to the glenoid were identified based on analysis of the separated portion of the glenoid fossa: including fractures of the superior glenoid (14 cases, 16 %), the anterior glenoid (23 cases, 23 %), the posterior rim of the glenoid (5 cases, 6 %), the inferior glenoid (38 cases, 42 %) and the entire glenoid (10 cases, 11 %). CONCLUSION: The proposed classification of glenoid fractures defines five basic types of fractures verified by 3D CT reconstructions and intra-operative findings. It respects the anatomical architecture of scapula, fracture mechanism, associated injuries to the shoulder girdle and, where appropriate, the preferred surgical approach.

• MeSH
• Adult MeSH
• Fractures, Bone classification   diagnostic imaging   pathology   surgery   MeSH
• Physical Examination MeSH
• Glenoid Cavity injuries   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Intraoperative Period MeSH
• Tomography, X-Ray Computed MeSH
• Shoulder Injuries MeSH
• Shoulder Joint diagnostic imaging   pathology   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Imaging, Three-Dimensional 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
• Research Support, Non-U.S. Gov't MeSH

Úvod: Zlomeniny postihující celou kloubní plochu glenoidu jsou označovány jako kominutivní zlomeniny nebo úplné zlomeniny glenoidu. Nicméně v literature není možné nalézt studie, které by se touto problematikou detailně zabývaly, nalézt lze pouze krátké zmínky. Metody: Soubor tvořilo 12 pacientů průměrného věku 39 roků, kteří utrpěli 13 zlomenin glenoidu. Ve všech případech byly všechny úlomky kloubní plochy odděleny od krčku nebo těla lopatky. Celkem 5 pacientů (6 zlomenin) bylo léčeno konzervativně a 7 patientů bylo operováno. Volba způsobu léčby záležela na dislokaci úlomků i pacientově celkovém a lokálním stavu. Indikací k operaci byla dislokace kloubních úlomků více jak 3 mm. Toto kritérium bylo zjištěno u 10 zlomenin (11 zlomenin). Vzhledem k celkovém či lokálnímu stavu byla operace kontrainidikována u 2 pacientů, resp. u 3 zlomenin; jedna pacientka operaci odmítla. Jeden pacient s oboustranou zlomeninou glenoidu byl pro sledování ztracen. Výsledky: Podle oblasti separace kloubních úlomků od ostatních částí lopatky byly zlomeniny rozděleny do tří skupin – separace v anatomickém krčku; separace v oblasti korakoideu či chirurgického krčku; či separace v těle lopatky. U 6 ze 7 pacientů jsme dosáhli dobrého nebo velmi dobrého výsledku. U 2 pacientů s minimální dislokací úlomků léčených konzervativně se zlomeniny zhojily v anatomickém postavení a bylo dosaženo plného rozsahu pohybu. U 2 pacientů s výraznou dislokací fragmentů léčených konzervativně došlo ke zhojení s inkogruentní kloubní plochou a k omezení rozsahu pohybu. Závěr: Zlomeniny celého glenoidu patří mezi nejzávažnější poranění lopatky. Jejich diagnostika vyžaduje CT vyšetření včetně 3D rekonstrukcí se subtrakcí okolních kostí. Dislokované zlomeniny jsou indikovány k operační léčbě z Judetova přístupu.

Introduction: Fractures affecting the entire glenoid fossa are termed comminuted or total glenoid fractures. However, there are no detailed studies of total glenoid fractures, and only brief mentions can be found in the literature. Methods: The group comprised 12 patients (mean age, 39 years), who sustained 13 fractures of the glenoid fossa. In all the fractures, all parts of the glenoid fossa were separated from the scapular neck or body. In total 5 patients (6 fractures) were treated non-operatively and 7 patients were operated on. The method of treatment was based on displacement of the fragments, the patient´s general and local conditions. Indication for operative treatment was displacement of articular fragments of more than 3mm. This criterion was met by 10 patients (11 fractures). Owing to the general or local condition, operation was contraindicated in 2 patients with 3 fractures; one patient refused the operation. One patient with a bilateral fracture was lost to follow-up. Results: According to the site of separation of articular fragments, the fractures were divided into three groups – the separation line passed through the anatomical neck; through the coracoid process or surgical neck of the scapula; or through the scapular body. In 6 of the 7 operated patients, a good or very good result was achieved. In 2 patients with minimal fragment dislocation treated non-operatively, the fractures healed in an anatomical position and full range of motion was achieved. In 2 patients with severe fragment displacement treated non-operatively, the healing resulted in glenoid fossa incongruence and painful and limited range of motion. Conclusion: Fractures of the entire glenoid fossa are the most severe injuries to scapula. Their diagnosis requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment from the Judet approach.

• Keywords
• Judetův přístup,
• MeSH
• Adult MeSH
• Fracture Fixation methods   MeSH
• Fractures, Bone * classification   radiography   therapy   MeSH
• Glenoid Cavity surgery   injuries   MeSH
• Middle Aged MeSH
• Humans MeSH
• Scapula * surgery   injuries   MeSH
• Adolescent MeSH
• Orthopedic Procedures methods   MeSH
• Postoperative Complications MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

OBJECTIVE: To investigate the relationship between osseous variations of the glenoid fossa and thinning of the overlaying articular cartilage. MATERIALS AND METHODS: In total, 360 dry scapulae, comprising adult, children and fetal specimens, were observed for potential presence of osseous variants inside the glenoid fossa. Subsequently, the appearance of the observed variants was evaluated using CT and MRI (each 300 scans), and in-time arthroscopic findings (20 procedures). New terminology of the observed variants was proposed by an expert panel formed by orthopaedic surgeons, anatomists and radiologists. RESULTS: Tubercle of Assaky was observed in 140 (46.7%) adult scapulae, and an innominate osseous depression was identified in 27 (9.0%) adult scapulae. Upon radiological imaging, the tubercle of Assaky was found in 128 (42.7%) CTs and 118 (39.3%) MRIs, while the depression was identified in 12 (4.0%) CTs and 14 (4.7%) MRIs. Articular cartilage above the osseous variations appeared relatively thinner and in several young individuals was found completely absent. Moreover, the tubercle of Assaky featured an increasing prevalence with aging, while the osseous depression develops in the second decade. Macroscopic articular cartilage thinning was identified in 11 (55.0%) arthroscopies. Consequently, four new terms were invented to describe the presented findings. CONCLUSION: Physiological articular cartilage thinning occurs due to the presence of the intraglenoid tubercle or the glenoid fovea. In teenagers, the cartilage above the glenoid fovea may be naturally absent. Screening for these variations increases the diagnostic accuracy of glenoid defects. In addition, implementing the proposed terminological updates would optimize communication accuracy.

• MeSH
• Child MeSH
• Adult MeSH
• Cartilage, Articular * diagnostic imaging   MeSH
• Glenoid Cavity * diagnostic imaging   MeSH
• Humans MeSH
• Scapula MeSH
• Magnetic Resonance Imaging MeSH
• Adolescent MeSH
• Tomography, X-Ray Computed MeSH
• Shoulder Joint * MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH

»: Fractures of the growing scapula account for about 0.1% of all pediatric fractures, with the majority occurring at an age of ≥10 years. »: Radiographic diagnosis requires a detailed knowledge of the ossification sequence of the growing scapula. Computed tomography examination is indicated for displaced fractures of the glenoid fossa, the scapular neck, and complex fractures; magnetic resonance imaging should be performed in cases of suspected injury to the physis and with stress fractures, depending on patient age and the potential need for general anesthesia during the scanning process. »: Separation of the base of the coracoid process is often associated with acromioclavicular dislocation. Clavicular fractures rarely occur in combination with injuries to the growing scapula. »: The majority of scapular fractures can be treated nonoperatively. Indications for surgery are displaced intra-articular fractures, scapular neck fractures with a displacement of >2 cm, coracoid base separation associated with acromioclavicular dislocation, and scapulothoracic dissociation. »: Displaced intra-articular fractures of the glenoid fossa should be followed after healing until skeletal maturity. Complications are rare and occur most frequently with scapulothoracic dissociation.

• MeSH
• Child MeSH
• Shoulder Fractures * MeSH
• Clavicle diagnostic imaging   injuries   MeSH
• Glenoid Cavity * MeSH
• Humans MeSH
• Scapula surgery   MeSH
• Adolescent MeSH
• Fracture Fixation, Internal MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Tento článek je pojat jako ujasňující a názorné sdělení v rozsáhlé a často nejasné problematice bolestivého ramene. Článek je rozdělen do třech částí. Tato první část poukazuje na základní důležité fylogenetické souvislosti vývoje funkce ramene a současné kineziologické poznatky biomechaniky ramene vedoucí k pochopení vzniku bolestivého funkčního a následně i strukturálního postižení pletence ramenního kloubu. Druhá část uvádí nejčastější a nejznámější klinické příznaky u těchto poruch ramene. Nabízí jednoduché dělení bolestí ramene podle etiologie, podle typu a podle rozsahu poškozených tkání a zpřehledňuje nespecifické přenesené bolesti v oblasti ramene. Třetí závěrečná část je věnována obecnému cíli a základní strategii léčebné rehabilitace bolestivého ramene s vybranými příklady konkrétních známých, osvědčených, ale i nejnovějších terapeutických postupů a metod. U každé z nich je zdůrazněn jejich princip a výhody pro použití v rehabilitační praxi. Klíčová slova: biomechanika, statické a dynamické stabilizátory ramenního kloubu, scapulothorakální rytmus, rotátorová manžeta, stereotyp abdukce ramene, svalové smyčky

The aim of the article is to clarify and illustrate the often unclear issue of the broad area of shoulder pain. The article consists of three parts. This first part refers to basic important phylogenetic connections between shoulder functional development and the current kinesiological knowledge of shoulder biomechanics that lead to understanding the origin of the aching functional and subsequently also structural disability in shoulder joint girdle. The second part introduces the most frequent and best known clinical symptoms of these shoulder disorders. It offers simple classification of shoulder aches according to etiology, type and extent of the injured tissues and it clarifies non-specific transmitted shoulder aches. The third closing part of the article is devoted to the general aim and basic strategy of aching shoulder medical rehabilitation, including specific examples of known and tested, as well as the latest therapeutic procedures and methods. Principles and advantages of their use in rehabilitation are emphasized. Keywords: biomechanics, static and dynamic stabilizers of the shoulder joint, scapulo humeral rhythm, rotator cuff, shoulder abduction stereotype, muscular loops

• MeSH
• Biomechanical Phenomena * physiology   MeSH
• Shoulder Pain physiopathology   MeSH
• Phylogeny MeSH
• Disease Attributes MeSH
• Glenoid Cavity anatomy & histology   physiology   MeSH
• Muscle, Skeletal * physiology   physiopathology   MeSH
• Humans MeSH
• Scapula * anatomy & histology   physiology   physiopathology   MeSH
• Motor Activity MeSH
• Signs and Symptoms MeSH
• Shoulder Joint * anatomy & histology   physiology   physiopathology   MeSH
• Shoulder * anatomy & histology   physiology   physiopathology   growth & development   MeSH
• Rotation MeSH
• Rotator Cuff * anatomy & histology   physiology   physiopathology   MeSH
• Range of Motion, Articular physiology   MeSH
• Muscles physiology   MeSH
• Check Tag
• Humans MeSH

OBJECTIVE: The aim of this study is to determine normal glenopolar angle (GPA) values on bone specimens of the scapula and compare them with various radiological views and CT examination. MATERIALS AND METHODS: GPA values were measured on 100 mature, dry, non-paired scapulae, 20 pairs of dry scapulae, 50 AP radiographs of the shoulder, 50 Neer I views, 50 AP chest radiographs and 20 3D CT reconstructions of the scapula. RESULTS: Measurements made on bone specimens of the scapula showed an average GPA value of 42.3°; the mean absolute side-to-side difference was on average 1.6°. The average GPA measured on 50 AP shoulder radiographs was 35.9°, on Neer I views 40.6° and AP chest radiographs 37.1°, with the mean absolute side-to-side difference on average 4.9°; on 3D CT the average GPA was 43.0° and the mean absolute side-to-side difference on average 1.4°. CONCLUSION: GPA values depend on the method of measurement used. Measurements made on 3D CT reconstructions and Neer I views showed almost the same values as those measured on bone specimens. The values measured on AP shoulder views and AP chest radiographs were statistically significantly lower. Side-to-side variability (right and left) measured on 3D CT reconstructions was insignificant, and the obtained values corresponded to the values from bone specimens. Therefore, the best method to measure the GPA is a 3D CT reconstruction and an exact Neer I projection.

• MeSH
• Models, Anatomic * MeSH
• Arthrometry, Articular methods   MeSH
• Glenoid Cavity anatomy & histology   radiography   MeSH
• Humans MeSH
• Cadaver MeSH
• Tomography, X-Ray Computed methods   MeSH
• Reference Standards MeSH
• Reproducibility of Results MeSH
• Sensitivity and Specificity MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Approximately, one-third of patients with tumors of proximal humerus will require an extra-articular resection to achieve oncologic margins. This procedure yields poor functional outcomes with a considerable rate of revisions. Unconstrained implants are prone to instability hindering also function of the elbow and hand, whereas constrained shoulder reconstructions suffer from early aseptic loosening of the glenoid component due to bone overload. The purpose of this study was to develop a constrained implant suitable for extra-articular resection with loss of function in deltoid and rotator cuff, which would provide both stability and passive motion, whilst also decreasing the risk of aseptic loosening of the glenoid component. METHODS: In cooperation with Czech Technical University in Prague, we devised an implant consisting of two constrained joints in series connected by a dumbbell piece. The biomechanical analysis showed a reduction of load transfer to the glenoid component with a torque of 8.6 Nm capable of generating an 865-N pulling force on bone screw to just 0.07 Nm, hence shielding the glenoid component from undesired forces and decreasing the risk of aseptic loosening. Three patients with extra-articular resection with a total loss of function of both rotator cuff and deltoid muscle received this type of reconstruction. The average follow-up was 16 months. RESULTS: The surgical technique is straightforward. The surgery took 175 min on average with average blood loss of 516 ml. There were no surgical- or implant-related complications. All three patients were pain-free and had a stable shoulder joint after the reconstruction. All had fully functional elbow, wrist, and hand joints. The average Musculoskeletal Tumor Society (MSTS) score was 21/30 (70%). All patients were pleased with the results. CONCLUSION: The presented innovative implant design has demonstrated to be a promising alternative for reconstruction in these challenging cases.

• MeSH
• Humerus MeSH
• Humans MeSH
• Scapula MeSH
• Postoperative Complications etiology   MeSH
• Shoulder Joint * surgery   MeSH
• Shoulder MeSH
• Plastic Surgery Procedures * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

PURPOSE: The objective of the study was to provide statistical evaluation of position of bone landmarks of proximal humerus in relation to transepicondylar line and find out which one is the most suitable for setup of the head retroversion in case of humeral head destruction. METHODS: We measured 185 dry humeral preparations (92 left, 93 right). Structures of interest on the proximal humerus were marked with pointers of custom made steel frame. Angular relationships between the humeral head axis and medial margin of the greater tuberosity, lateral margin of the lesser tuberosity, bicipital groove, and crest of the greater tuberosity were evaluated with respect to intramedullary axis of the proximal humeral shaft. RESULTS: The angle between the humeral head axis and medial margin of greater tuberosity was 11.5 +/- 9.0 degrees , the angle between the lateral margin of the lesser tuberosity and the axis was 47.5 +/- 7.4 degrees , the angle between the bicipital groove and the axis was 31.6 +/- 8.8 degrees at the level of the humeral head. The angle between the crest of the greater tuberosity and the axis was 26.6 +/- 9.6 degrees in plane of the surgical neck. CONCLUSIONS: We statistically proved that the lateral margin of lesser tuberosity is more reliable than the bicipital groove; medial margin of the greater and transepicondylar line for reconstruction of humeral head retroversion. We suggest that the lesser tuberosity should be used to determine the retroversion, especially in cases when the margin of humeral head was destructed.

• MeSH
• Arthroplasty MeSH
• Humerus anatomy & histology   MeSH
• Humans MeSH
• Shoulder Joint anatomy & histology   surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Anatomická hemiartroplastika ramenního kloubu je výkon, u kterého je funkční výsledek velmi závislý na správné indikaci, operační technice a následné rehabilitaci. Operační technika se odlišuje u chronických degenerativních onemocnění ramena a u traumatických stavů. V těchto případech je zásadní optimální rekonstrukce a refixace velkého a malého hrbolu humeru s neporušenými úpony rotátorové manžety.

Anatomical hemiarthroplasty of the shoulder joint is a procedure for which the functional outcome highly depends on correct indication, surgical technique and subsequent rehabilitation. Surgical technique differs for chronic degenerative diseases and traumatic conditions of the shoulders. In these cases optimal reconstruction and fixation of the fixation of the greater and lesser tuberosity of the humerus with intact rotator cuff insertions is essential.

• Keywords
• anatomická náhrada,
• MeSH
• Hemiarthroplasty * methods   instrumentation   MeSH
• Humerus surgery   MeSH
• Humans MeSH
• Prosthesis Design * MeSH
• Joint Prosthesis MeSH
• Shoulder Joint * surgery   MeSH
• Rotator Cuff surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH