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.

• Klíčová slova
• Judetův přístup,
• MeSH
• dospělí MeSH
• fixace fraktury metody   MeSH
• fraktury kostí * klasifikace   radiografie   terapie   MeSH
• kloubní jamka lopatky chirurgie   zranění   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lopatka * chirurgie   zranění   MeSH
• mladiství MeSH
• ortopedické výkony metody   MeSH
• pooperační komplikace MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• artroskopie metody   MeSH
• lidé MeSH
• luxace ramenního kloubu diagnóza   chirurgie   MeSH
• poranění ramene MeSH
• ramenní kloub chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví 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
• artroskopie veterinární   MeSH
• lopatka * chirurgie   diagnostické zobrazování   patologie   MeSH
• osteochondróza * chirurgie   diagnostické zobrazování   patologie   veterinární   MeSH
• počítačová rentgenová tomografie veterinární   MeSH
• psi MeSH
• ramenní kloub chirurgie   diagnostické zobrazování   patologie   MeSH
• zchromnutí zvířat chirurgie   patologie   MeSH
• zobrazování trojrozměrné veterinární   MeSH
• zvířata MeSH
• Check Tag
• psi MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• kazuistiky 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
• dospělí MeSH
• fraktury kostí klasifikace   diagnostické zobrazování   patologie   chirurgie   MeSH
• fyzikální vyšetření MeSH
• kloubní jamka lopatky zranění   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• peroperační doba MeSH
• počítačová rentgenová tomografie MeSH
• poranění ramene MeSH
• ramenní kloub diagnostické zobrazování   patologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

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
• dospělí MeSH
• fraktury proximálního humeru diagnostické zobrazování   chirurgie   MeSH
• kloubní jamka lopatky diagnostické zobrazování   zranění   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie metody   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury škodlivé účinky   metody   MeSH
• zobrazování trojrozměrné metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články 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
• dítě MeSH
• dospělí MeSH
• kloubní chrupavka * diagnostické zobrazování   MeSH
• kloubní jamka lopatky * diagnostické zobrazování   MeSH
• lidé MeSH
• lopatka MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• počítačová rentgenová tomografie MeSH
• ramenní kloub * MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Differentiating the anatomical variations of the anterosuperior portion of the glenoid labrum from pathologies is important to avoid unnecessary iatrogenic complications resulting from inaccurate diagnosis. Additionally, the presence of several variations was reported to be conductive to lesions involving the glenoid labrum. Thus, the aim of this study was to state the prevalence rates of the sublabral recess, sublabral foramen, and the Buford complex, and to verify their association with labral lesions. METHODS: Systematic search of electronic databases was conducted to gain potentially eligible literature. Suitable studies were selected in a two-round screening, and relevant data were subsequently extracted. Calculation of the pooled prevalence estimates, including sub-analyses on cohort size, study type, and geographical variance, was conducted. Pooled analysis of risk ratios (RR) was used to assess the conductive nature of the discussed variants to superior labrum anterior to posterior (SLAP) lesions. RESULTS: The screening resulted in selection of 20 studies investigating the morphological features of the glenoid labrum, consisting of 7601 upper limbs. On the bases of random-effects meta-analysis the sublabral recess, sublabral foramen and Buford complex occur with a pooled prevalence of 57.2% (95% CI 30.0-84.4%), 13.5% (95% CI 8.2-18.9%), and 3.0% (95% CI 1.5-4.5), respectively. Moreover, individuals with Buford complex have RR 2.4 (95% CI 1.3-4.7) of developing SLAP lesions, especially type II (95.5%; 95% CI 86.1-100%), whereas such risk for sublabral recess and sublabral foramen was not statistically significant. CONCLUSION: Morphological variants of the glenoid labrum posing diagnostic confusion are frequently observed. Gradually, the Buford complex may be a predisposing factor for sustaining a SLAP lesion.

• MeSH
• artroskopie MeSH
• horní končetina MeSH
• lidé MeSH
• poranění ramene * epidemiologie   MeSH
• prevalence MeSH
• ramenní kloub * patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

BACKGROUND: Preoperative planning with the aid of imaging methods is a principal factor in successful surgery on the shoulder. This work aims to evaluate the variability of glenoid version, spiralling twist and scapular inclination in relation to the frontal axis. Studies focusing on measuring the variability of scapular inclination in the standardised rest position are lacking in the literature. METHODS: We evaluated 104 CT scans of the shoulder. We measured the glenoid version with respect to the scapular axis at three levels. We measured the scapular inclination angle in relation to the sagittal plane and we determined scapular inclination in relation to the frontal axis. Statistical evaluation was performed using the marginal linear model and parameters were estimated using the generalised least squares method, which enables the dependency of measurements performed on the same subject to be taken into consideration. RESULTS: The highest values of retroversion are attained by the glenoid in the cranial section (average -9.96°, range -29.7 to +13.2°). Proof of the spiralling twist is the decline in retroversion at the centre of the glenoid (average -2.09°, range -16.7 to +11.6°). Retroversion decreases further in the inferior direction (average -0.5°, range -20.9 to +17.5°). The average thoracoscapular angle is 45.46°, ranging from 13.1 to 69.0°. The average scapular inclination in relation to the frontal plane is 44.54°, ranging from 21.0 to76.9°. CONCLUSIONS: During preoperative planning, the surgeon should take into consideration not only the glenoid version in relation to the scapular axis, but also the value of the scapular inclination so as to eliminate possible surgical errors, optimise prosthesis implantation and thus decrease the risk of functional restrictions of the joint. CLINICAL TRIAL REGISTRATION: Ethics Committee for Multi-Centric Clinical Trials (EK-554/14,29thApril 2014).

• MeSH
• anatomická variace MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lopatka anatomie a histologie   diagnostické zobrazování   MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• předoperační péče MeSH
• ramenní kloub anatomie a histologie   diagnostické zobrazování   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Bio-absorbable anchors are widely used for Bankart repair in shoulder instability surgery. Suture anchor placement for labral repair may give rise to osteolysis and/or create stress risers in the glenoid rim, which may be the underlying reasons for glenoid rim fracture with a fracture line passing through previous anchor placement sites, the so-called "postage stamp fracture". Intraarticular fractures of the glenoid have been treated via open reduction and internal fixation through an arthrotomy, which may lead to potential postoperative complications like infection, neurovascular injuries, joint stiffness, and a long recovery period. Thus, arthroscopic techniques for the reduction and fixation of glenoid fractures have been developed. We present a case of anterior glenoid rim postage stamp fracture 9 years after glenohumeral instability surgery in a 29- year-old male. The fracture and recurrent instability were treated via arthroscopic Bankart revision repair and arthroscopic assisted percutaneous screw fixation, where the arthroscopic fracture reduction and definitive fixation were performed separately and before Bankart repair, which is different from the techniques defined in the literature previously. The patient was able to return to work at 6 weeks, to fitness training without pain or restriction at 3 months, and contact sports 6 months postoperatively. Key words: Bankart fractures, bony Bankart lesion, osseous Bankart lesion, shoulder dislocation, arthroscopy.

• MeSH
• artroskopie MeSH
• dospělí MeSH
• filatelie * MeSH
• kostní šrouby MeSH
• lidé MeSH
• lopatka MeSH
• luxace ramenního kloubu * chirurgie   MeSH
• nestabilita kloubu * etiologie   chirurgie   MeSH
• ramenní kloub * chirurgie   MeSH
• recidiva MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY The purpose of the study is to share the first experience of authors with the management of glenoid defects by a bone graft in reverse total shoulder arthroplasty. MATERIAL AND METHODS Evaluation of 7 patients was conducted, who underwent reverse total shoulder arthroplasty at the authors' department. Due to the presence of glenoid bone defect, augmentation was performed by bone graft, obtained either as an autograft harvested from the humeral head of the patient intraoperatively or as an allograft from the femoral head from the bone tissue bank. In all the implantations, a glenoid component with an extra-long "revision" peg was used. Postoperative fixation was secured only by a shoulder brace. Limited rehabilitation was commenced on the first postoperative day, full rehabilitation 5 weeks after the surgery. RESULTS The total ASES Shoulder Score increased from the mean 39.8 preoperatively to 75.2 postoperatively. Also, the overall range of motion improved, with the preoperative ventral flexion increasing from the mean 65.5° to 135.2°, abduction increasing from 63.9° preoperatively to 127.7° postoperatively, and external rotation increasing from 27.4° preoperatively to 45.1° postoperatively. In the evaluated group, 2 complications were observed, namely 1 case of bone graft breakage intraoperatively, necessitating the harvesting of a new bone graft, and 1 case of postoperative paresthesia of the fourth and the fifth finger, which completely disappeared within 4 months after the surgery. In the group of followed-up patients, no loosening of endoprosthetic components has so far been reported. DISCUSSION Glenoid defect constitutes one of the problems that need to be dealt with by the surgeon during the reverse total shoulder arthroplasty, most often it is accompanied by glenoid retroversion. The basic approach to defect management is to use the eccentric reaming technique which is, however, limited by the size of glenoid retroversion and can also worsen the already present glenoid medialization, with all the resulting consequences. Another option is to use solid bone grafts to correct glenoid version and simultaneously to lateralize the glenoid component. Yet another option is to use the prefabricated glenoid augments that are, however, not commonly available in the Czech market. CONCLUSIONS The short-term clinical outcomes of patients, in whom glenoid defect was during the reverse total shoulder arthroplasty managed by bone grafts, are very good. Radiological signs of bone-to-graph incorporation were present in all the patients of the followed-up group. Nonetheless, for the sake of evaluation of this method, more patients shall be included in the group and a longer follow-up is needed for their evaluation. Key words: reverse total shoulder arthroplasty, glenoid bone loss, glenoid retroversion, augmented implant.

• MeSH
• artroplastika ramenního kloubu metody   MeSH
• autologní transplantace MeSH
• hlavice femuru transplantace   MeSH
• hlavice humeru transplantace   MeSH
• homologní transplantace MeSH
• lidé MeSH
• lopatka chirurgie   MeSH
• ramenní kloub chirurgie   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• transplantace kostí metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH