Fractures of the Neck of the Scapular

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Fractures of the Neck of the Scapular

Isolated fracture of the scapular neck

In most of the cases of minimally displaced scapula fractures without the involvement of the ipsilateral shoulder girdle or ipsilateral chest wall, early functional treatment shows good results. However, a highly displaced scapular fracture requires operative treatment.

The inserting triceps muscle attachment at the infra glenoid tubercle can pull the glenoid distally and tilt it laterally. The selection of the implant depends on the fragment size and the pattern of the fracture. Locking Proximal Radial Head Neck Plates are indicated for fractures of the multi-fragmented radial neck fractures and fractures of the proximal radius. For the treatment of radial head fracture surgeon uses radial head prosthesis which can be acquired by orthopedic implant company.

 As per the posterior approach, the individual lag screws can be driven into the tubercle from behind. Larger fragments should be buttressed posteriorly using a one-third tubular plate, pressing the articular fragment against the proximal lateral border of the scapula. The stability of the external fixator is enhanced by combining the plate with a 3.5 mm cortex lag screw. Combining the plate with a 3.5 mm cortex lag screw increases the stability of the fixation.

Combination fractures with scapular neck fractures

When displaced scapular neck fracture and a fracture of the clavicle or rib fractures occur combinedly on the same side, the shoulder girdle turns unstable. The weight of the arm drags both the shoulder and the chest wall, distally and anteriorly, which may compromise the volume of the chest. The extent of displacement and instability of the scapular neck depends on the integrity of the acromioclavicular ligaments and coracoclavicular. In such a situation, related injuries of the brachial plexus are usual.

To restore the stability, first of all, the clavicle is to be fixed that attaches the shoulder girdle to the sternum. The fixation of the clavicular fracture is done using LC-DCP 3.5, DCP 3.5, or reconstruction plate 3.5. This generally decreases the neck fracture to a certain extent. Further fixation of the scapular neck fracture is needed hardly.

Acromion Fractures and coracoid process

Displaced fractures and painful non-unions are indicators of operative treatment. An acromion lateral fracture can be stabilized with K-wires and a tension band. Small fragments can be removed, and a detached deltoid muscle is re-joined in a trans osseous manner

In case of clear coracoclavicular displacement or compromise of the neurovascular bundle in coracoid process fracture, operative surgery is required. However, internal fixation is used after osteotomy of the coracoid so that access to the anterior part of the shoulder joint can be attained.  The use of a screw of the proper size for the patient’s bone is sufficient for inter-fragmentary screw compression. A tension band wire can be added to it.

After 3-4 days of surgery, temporary immobilization in a Gilchrist or Desault sling is advised. After treatment active and assisted function can be started. A complete program of the rotator cuff strengthening with resistive exercises is requisite after the third week of surgery for better results.

The result is partially determined by the initial damage to the cartilage of the glenohumeral joint due to the high impact and to a certain extent by the quality of the reduction. Hardegger and Simpson have reported based on their study on 37 operated patients 79% good to excellent results. Whereas others have reported good results in 75% of operated intra-articular glenoid fracture patients.

 

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