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

When internal fixation of the scapular neck and body fractures is performed, a problem may occur with reduction and retention of position of the lateral border of the scapula during surgery. For this purpose, the authors have developed their own technique of stabilization using a K-wire in a novel way. The technique is indicated in a 2-part shear unstable fracture of the lateral border. It cannot be used in fractures with an intercalated segment. A 2.5-mm drill bit is used to drill a 1.5-cm deep hole into the "medullary cavity" of each of the 2 fragments of the lateral border. A K-wire, 1.5 mm in diameter and 2.5-cm long, is inserted into the distal fragment. The protruding end of the K-wire is inserted into the hole in the proximal fragment. This intramedullary peg helps to maintain reduction and keeps both fragments stable. Subsequently, the lateral border is stabilized with a 3.5-mm reconstruction plate. This technique is quite simple and allows for a temporary stabilization of fragments without compromising the subsequent fixation by plate screws.

• MeSH
• fraktury kostí chirurgie   MeSH
• kostní destičky MeSH
• kostní dráty MeSH
• lidé středního věku MeSH
• lidé MeSH
• lopatka chirurgie   zranění   MeSH
• osteotomie metody   MeSH
• vnitřní fixace fraktury metody   přístrojové vybavení   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví 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

• MeSH
• muskuloskeletální nemoci rehabilitace   MeSH
• nervová blokáda MeSH
• propriocepce MeSH
• rehabilitace metody   MeSH
• strečink MeSH

• Konspekt
• Fyzioterapie. Psychoterapie. Alternativní lékařství
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• rehabilitační a fyzikální medicína
• rehabilitační a fyzikální medicína
• ortopedie
• NLK Publikační typ
• učebnice vysokých škol
• kolektivní monografie

UNLABELLED: In this study, we investigated the effect of regular walking and its combination with manual techniques/resistance exercise. The position of the shoulder girdle was assessed using the acromion-wall distance (AD). The intervention took place twice a week for 4 weeks. A total of 88 seniors over the age of 60 successfully completed the study. The results showed a statistically significant improvement of AD in the left shoulder within the group that underwent walking combined with resistance exercise. The remaining groups did not show any statistically significant change in AD. BACKGROUND: The world population is rapidly aging; therefore, it is necessary to respond to this challenge in time. One of the typical involutional signs of old age is a hunched posture combined with a forward position of the shoulder girdle. This posture negatively impacts various bodily functions, postural stability, and strain on the musculoskeletal system. OBJECTIVES: We aimed to evaluate the effect of walking and walking combined with manual therapy/resistance exercise on scapular positioning in healthy elderly individuals. METHODS: Participants of experimental groups underwent a 4-week training session that involved walking and manual techniques/resistance training applied 2x/week. Participants of the control group maintained their usual daily habits. RESULTS: Our results showed statistically significant improvement in scapular positioning of the left shoulder in participants who underwent regular walking combined with resistance exercise training. CONCLUSIONS: These results suggest that regular walking combined with resistance training, when properly dosed, may beneficially influence scapular positioning in healthy elderly individuals.

• Publikační typ
• časopisecké články MeSH

Operační léčba dislokovaných intra- a extraartikulárních zlomenin lopatky nabývá na aktuálnosti. Nezbytností při její indikaci je přesné určení typu zlomeniny a její dislokace. K tomu jsou nutné nejen obě Neerovy projekce, ale i 3D CT rekonstrukce při pohledu ze zadní, laterální, přední a mediální strany se subtrakcí hlavice humeru a klíčku. Cíl operační léčby závisí na typu zlomeniny. U dislokovaných intraartikulárních zlomenin je to obnovení kongruence a stability kloubu. U dislokovaných extraartikulárních zlomenin výběžků, především korakoideu, akromia a spiny, je cílem dosáhnout zhojení v anatomickém postavení, neboť zhojení v dislokaci může komprominovat rotátorovou manžetu. U dislokovaných extraartikulárních zlomenin těla a krčku lopatky je cílem obnovení původního postavení glenoidu a biomechanického těla lopatky (gleno-polární úhel), tzn. rekonstrukce délky a integrity laterálního okraje. Pro normální pohyb lopatky je důležité obnovit i kongruenci mezi její přední plochou a hrudní stěnou, popř. odstranit fragmenty lopatky zaražené v hrudní stěně. V současné době jsou k operační léčbě indikovány extraartikulární zlomeniny těla a krčku lopatky splňující tato kritéria: 100% translace fragmentů laterálního okraje, 25° úhlová dislokace glenoidu k laterálnímu okraji lopatky, medializace glenoidu vzhledem k laterálnímu okraji větší než 1 cm, fragment lopatky zaražený do hrudní stěny. Vzhledem k tomu, že většina zlomenin lopatky je operována odloženě, je nutná identifikace všech základních úlomků a jejich dokonalé očištění od formujícího se svalku. U zlomenin těla a krčku lopatky je laterální pilíř klíčovou strukturou pro úspěšnou osteosyntézu. Je třeba obnovit jeho délku a osový vztah ke glenoidu. Pro fixaci laterálního okraje se osvědčila 3.5 rekonstrukční DCP dlaha s dvěma šrouby v každém z hlavních fragmentů (2+2). Stabilitu osteosyntézy zlomenin těla výrazně zvýší fixace zlomeniny mediálního okraje.

Surgical treatment of displaced intra- and extra-articular fractures of the scapula becomes a topical issue. Exact determination of the type of the fracture and its displacement represents necessary prerequisite for its indication. This requires the two Neer views as well as 3D CT reconstruction from the posterior, lateral, anterior and medial views with subtraction of the humeral head and the clavicle. The aim of surgical treatment depends on the type of fracture. In displaced intra-articular fractures it is the restoration of the congruency and stability of the joint. In displaced extra-articular fractures of processes, particularly of the coracoid, acromion and spine, the aim is to achieve healing in anatomical position, since healing in displacement may compromise the rotator cuff. In displaced extra-articular fractures of the scapular body and neck the objective of treatment is to restore the anatomical position of the glenoid to the lateral border of the scapular body (the gleno-polar angle), i.e. to reconstruct the length and integrity of the lateral border. To achieve the normal range of motion of the scapula the restoration of congruency between its anterior surface and the chest wall is also important or, where necessary, it also requires removal of fragments penetrated into the chest wall. Indicated currently for surgical treatment are extra-articular fractures of the scapular body and neck that meet the following criteria: 100% translation of fragments of the lateral border, 25-degree displacement of the glenoid to the lateral border of the scapula, medial displacement of the glenoid to the lateral border exceeding 1cm, and a fragment of the scapula penetrated into the chest wall. Surgical treatment of fractures of the scapular body and neck requires adequate mastering of the posterior Judet approach. Given the fact that most of the fractures are operated on with a certain delay it is necessary to identify all important fragments and remove completely the callus being formed there. In particular it applies to intra-articular fragments and also to fractures of the lateral border, including its interfragments. In fractures of the scapular body and neck the lateral border is a key structure for a successful internal fixation. Therefore it is necessary to restore its length and axial alignment to the glenoid. The 3.5 reconstruction DCP plate with two screws in each of the main fragments (2+2) was proven suitable for fixation of the lateral border. Stability of internal fixation of the scapular body is considerably increased by fixation of the fracture of the medial border.

• MeSH
• lidé MeSH
• lopatka chirurgie   zranění   MeSH
• pooperační komplikace etiologie   MeSH
• pooperační péče metody   MeSH
• vnitřní fixace fraktury dějiny   metody   využití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy 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

• MeSH
• fyzikální vyšetření MeSH
• svaly fyziologie   MeSH
• Publikační typ
• příručky MeSH

• Konspekt
• Lékařské vědy. Lékařství
• NLK Obory
• ortopedie
• rehabilitační a fyzikální medicína

• MeSH
• anatomie průřezová MeSH
• anatomie topografická MeSH

• Konspekt
• Anatomie člověka a srovnávací anatomie
• NLK Obory
• anatomie
• NLK Publikační typ
• učebnice vysokých škol

• MeSH
• loket chirurgie   MeSH
• rameno chirurgie   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• chirurgie
• NLK Publikační typ
• učebnice vysokých škol
• kolektivní monografie