Surgical treatment of scapula body fractures extending glenoid fossa: Surgical technique and early results

BACKGROUND: The aim of this study was to describe the surgical technique and evaluate functional outcomes following open reduction and internal fixation in patients with scapular fractures.
METHODS: In this study, ten patients with scapular fractures with Ideberg type four and five, who had undergone operatively with the Judet approach in three different orthopedic centers between March 2014 and October 2018, were evaluated retrospectively. By the end of at least a 2-year follow-up period, postoperative Disabilities of the Arm, Shoulder and Hand (DASH), Constant questionnaires were evaluated by all participating patients.
RESULTS: Three of these patients had fractures on the left; seven patients had fractures on the right side, and the average patient age was 35.1±9.75. Mean Constant and DASH scores were 87.9±13.68 and 5.57±5.21, respectively. In two patients, about 2 cm adjacent to the suprascapular notch, perioperative suprascapular nerve injury was stated and sutured using the epineural technique. By the end of the 2-year follow-up of these two patients, infraspinatus muscle atrophy had occurred. However, external rotation muscle strength was 4/5 in both patients.
CONCLUSION: This study suggests that scapula fractures extending glenoid articular surface can be safely fixed through the Judet approach and had satisfactory results. In addition, two patients with traumatic suprascapular nerve injury were encountered during the surgery and repaired which may be hard to diagnose with modified or minimal incisional approaches.

Glenoid fossaya uzanan skapula cisim kýrýklarýnýn cerrahi tedavisi: Cerrahi teknik ve erken dönem sonuçlar

AMAÇ: Bu çalýþmanýn amacý, açýk redüksiyon ve internal fiksasyon yapýlan skapula kýrýklý hastalarda cerrahi tekniði tanýmlamak ve fonksiyonel sonuçlarý deðerlendirmekti.
GEREÇ VE YÖNTEM: Bu çalýþmada, Mart 2014 Eylül 2019 tarihleri arasýnda üç farklý merkezde, Ideberg tip dört ve beþ skapula kýrýklý, Judet yaklaþýmýyla ameliyat edilen 10 hasta geriye dönük deðerlendirildi. En az iki yýllýk takiplerin sonucunda, tüm hastalarýn DASH ve Constant skorlarý deðerlendirildi.
BULGULAR: Hastalarýn üçünde sol ve yedisinde sað tarafta kýrýk bulunmaktaydý ve ortalama yaþlarý 35.1±9.75’idi. Ortalama Constant ve DASH skorlarý sýrasýyla 87.9±13.68 ve 5.57±5.21’idi. Ýki hastada, yaklaþýk supraglenoid çentikten 2 cm’lik mesafede, supraskapular sinirde travmatik tam kat yaralanma tespit edildi ve epinöral teknikle tamir edildi. Ýki yýllýk takipler sonucunda hastalarda infraspinatus kas atrofisi geliþti.
TARTIÞMA: Sonuç olarak, bu çalýþma glenoid eklem yüzüne uzanan deplase skapula kýrýklý hastalarýn cerrahi tedavisinde Judet yaklaþýmýnýn tatminkar sonuçlarýyla güvenli bir tercih olduðunu desteklemektedir. Ek olarak, iki hastada rastlanan ve cerrahi sýrasýnda tamiri yapýlan travmatik supraskapular sinir hasarýnýn daha kýsýtlý veya modifiye yaklaþýmlarla taný konmasýnýn zor olacaðý kanaatindeyiz.