Magnetic resonance arthrographic demonstration of extension of labral defects in paraglenoid labral cysts

SUMMARY OBJECTIVE: This study aimed to investigate the extension of labral tears associated with paraglenoid labral cysts by magnetic resonance arthrography. METHODS: The magnetic resonance and magnetic resonance arthrography images of patients with paraglenoid labral cysts who presented to our clinic between 2016 and 2018 were examined. In patients with paraglenoid labral cysts, the location of the cysts, the relation between the cyst and the labrum, the location and extent of glenoid labrum damage, and whether there was contrast medium passage into the cysts were investigated. The accuracy of magnetic resonance arthrographic information was evaluated in patients undergoing arthroscopy. RESULTS: In this prospective study, a paraglenoid labral cyst was detected in 20 patients. In 16 patients, there was a defect in the labrum adjacent to the cyst. Seven of these cysts were adjacent to the posterior superior labrum. In 13 patients, there were contrast solution leak into the cyst. For the remaining seven patients, no contrast-medium passage was observed in the cyst. Three patients had sublabral recess anomalies. Two patients had rotator cuff muscle denervation atrophy accompanying the cysts. The cysts of these patients were larger compared to those of the other patients. CONCLUSION: Paraglenoid labral cysts are frequently associated with the rupture of the adjacent labrum. In these patients, symptoms are generally accompanied by secondary labral pathologies. Magnetic resonance arthrography can be successfully used not only to demonstrate the association of the cyst with the joint capsule and labrum, but also to reliably demonstrate the presence and extension of labral defects.

Research into the fixation stability of the glenoid baseplate in reverse shoulder arthroplasty / 中华创伤骨科杂志

Reverse shoulder arthroplasty (RSA) was proposed to deal with rotator cuff tear arthropathy in the 1970s and improved from 1985 to 1995 by Dr. Grammont who designed the contemporary type of reverse shoulder prosthesis successfully. The number of RSAs has grown rapidly over the past decade. Currently, the indications for RSA include, in addition to rotator cuff tear arthropathy, massive rotator cuff tears which can not be repaired, proximal humerus fractures or their sequelae, inflammatory shoulder disease, osteoarthritis with abnormal glenoid morphology, anatomic revision after failed total shoulder arthroplasty or hemiarthroplasty, and shoulder tumors. Absolute contraindications to RSA include infection, complete axillary nerve palsy, neuropathic shoulder arthropathy, and glenoid bone loss. At present, the stability of the glenoid baseplate, an important factor affecting the incidence of postoperative complications, is mainly achieved by implantation of the screws for the glenoid baseplate base. Therefore, correct implantation of the screws is of great significance to reduce the complications in RSA.

Glenoid Bone Loss - A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes / Falha óssea na glenoide - Uma avaliação retrospectiva dos desfechos funcionais após cirurgia de bloqueio ósseo para instabilidade anterior do ombro em atletas de alta demanda

Abstract Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability. Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%. Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups. Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Resumo Objetivo Avaliar a relação do tamanho do defeito ósseo da glenoide no arco de movimento, nos resultados funcionais e nas complicações em pacientes atletas de alta performance submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Método Estudo retrospectivo no qual foram avaliados os resultados pós-operatórios de atletas submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Em 5 anos foram 41 ombros operados, sendo 20 deles com até 15% de defeito ósseo e 21 com defeitos entre 15% e 25%. Resultados Não houve diferença estatisticamente significativa com relação a complicações pós-operatórias, novas luxações, e na taxa de retorno ao esporte. Os critérios quantitativos avaliados - arcos de movimento e escores funcionais - também não apresentaram diferença estatisticamente significativa entre os grupos. Conclusão O tamanho do defeito ósseo por si só não parece afetar os resultados funcionais e as complicações desses procedimentos, sendo uma técnica segura tanto para defeitos pequenos, quanto para os maiores.

A morphometric study of spinoglenoid notch, subcoracoacromial arch, and spinous process of the scapula on shoulder impingement

Introduction: Morphometric study of spinoglenoid notch, coracoacromial arch, and another measurement of the scapulae are required to understand the reason for spasms of common muscle due to supraspinatus tendinitis, nerve compression over the spinoglenoid notch. Therefore, the aim of this study was to discuss the subcoracoacromial arch, deviation of the spinous process, and measurement of the spinoglenoid notch. Materials and Methods: This study was conducted at the Department of Anatomy, Sri Venkateshwaraa Medical College Hospital & Research Centre, Chennai, Tamil Nadu, India on 70 scapulae that include 58 non-articulated scapulae and 12 articulated scapulae. All the measurements were performed with a vernier caliper and the alignment of the spinous process of the scapula was measured with a goniometer. All the measurements are compared on both sides. Results: All the measurements were performed and presented as mean with standard deviation. We found the variation of diameter between the left and right sides. Spinoglenoid notch diameters were noted as anterior to posterior right 2.97 ± 0.37 cm, left 3.06 ± 0.56 cm and medial to lateral right 1.36 ± 0.14 cm, left 1.4 ± 0.08 cm. Subcoracoacromial arch was observed as right 1.85 ± 0.23 cm and left 1.92 ± 0.4 cm. The direction of the spinous process of the scapula was noted as right 21.50º ± 8.50 and left 18.8º ± 7.89. Conclusion: The present morphometric study findings may give a different approach to supraspinatous tendinits, shoulder instability, and dislocation cases due to morphometric changes present in the spinous process, acromion process, glenoid cavity, and spinoglenoid notch of the scapula. These morphometric studies on scapula can help radiologists, orthopedicians, and physiotherapists to plan patient management.

Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability / Validação clínica do conceito de glenoid track na instabilidade glenoumeral anterior

Abstract Objective To evaluate the correlation of the glenoid track and glenoidal bone loss with the recurrence dislocation rate and the Rowe score. Methods Retrospective study that assessed the glenoid track and glenoidal bone loss through preoperative magnetic resonance imaging. Patients undergoing primary arthroscopic repair of anterior Bankart were included. Patients with glenoidal bone loss greater than 21%, rotator cuff tear, scapular waist fracture, and posterior or multidirectional instability were not included. Rowe score were the primary outcome, and the recurrence rate was the secondary outcome. Results One hundred and two patients were included. Postoperative recurrent instability was reported by 8 patients (7.8%). Four patients (50%) in the group with recurrence presented glenoidal bone loss greater than 13.5% against 24 (25.5%) in the group without recurrence (p= 0.210), with a negative predictive value of 94.6%. Three patients (37.5%) in the recurrence group were considered off-track, against 13 (13.8%) in the group without recurrence (p= 0.109), with a negative predictive value of 94.2%. Patients with absolute glenoid track value ≤ 1.5 mm had worse results in relation to the recurrence group, with 6 patients (75%) presenting recurrence (p= 0.003). Conclusion Off-track injury and glenoidal bone loss greater than the subcritical are not related to the recurrence rate and Rowe score, despite the high negative predictive value. The cut of the absolute value of the glenoid track at 1.5 mm had a significant relationship with the recurrence rate.

Resumo Objetivo Avaliar a correlação do conceito de glenoid track e da perda óssea da cavidade glenoidal com a taxa de recidiva de luxação e pontuação na escala de Rowe. Métodos Estudo retrospectivo que aferiu o glenoid track e a perda óssea da cavidade glenoidal por ressonância magnética pré-operatória. Foram incluídos pacientes submetidos a reparo artroscópico primário de Bankart anterior. Não foram incluídos pacientes com perda óssea da cavidade glenoidal maior que 21%, rotura do manguito rotador, fratura de cintura escapular, instabilidade posterior ou multidirecional. A pontuação pela escala de Rowe foi o desfecho primário, e a taxa de recidiva foi o desfecho secundário. Resultados Cento e dois pacientes foram incluídos. A recidiva foi relatada por 8 pacientes (7,8%). Quatro pacientes (50%) do grupo com recidiva apresentaram lesão da cavidade glenoidal maior que 13,5% contra 24 (25,5%) do grupo sem recidiva (p= 0,210), com valor preditivo negativo de 94,6%. Três pacientes (37,5%) do grupo com recidiva foram considerados off-track, contra 13 (13,8%) do grupo sem recidiva (p= 0,109), com valor preditivo negativo de 94,2%. Pacientes com valor absoluto do glenoid track menor ou igual a 1,5 mm tiveram piores resultados em relação ao grupo com recidiva, sendo que 6 pacientes (75%) apresentaram recidiva (p= 0,003). Conclusão Lesão off-track e perda óssea da cavidade glenoidal maior que a subcrítica não apresentam relação significativa com a taxa de recidiva e a pontuação de Rowe, apesar do alto valor preditivo negativo. O corte do valor absoluto do glenoid track em 1,5 mm apresentou relação significativa com a taxa de recidiva.

Sex determination from glenoid cavity by computed tomography in Turkish population / Determinación del sexo de la cavidad glenoidea mediante tomografía computarizada en la población turca

SUMMARY: The aim of this study is to contribute to sex determination studies from the scapula in the Turkish population and compare with previous studies. This study was performed with 200 scapulae (100 males and 100 females). The age range of the patients was between 18-93 years old. Computed tomography scans were used and length of glenoid cavity (LGC), breadth of glenoid cavity (BGC), depth of glenoid cavity (DGC), perimeter (PM) and volume (VL) were measured. Randomly selected 20 scapulae were measured three times for examine the intra-rater reliability from those measurements. Gender logistic regression analysis was conducted to find the significant variables at sex determination from the scapula. The most effective parameter in determining sex from scapula was found to be VL (88.5%). The effects of LGC, PM, BGC and DGC at sex determination from scapula were found to be 83%, 82.5%, 79.5%, 66%, respectively. The combination of VL and PM (89.5%) was found to be the most effective combination at sex determination from the scapula. The intraclass correlation values of all measurements were found to be at high reliability. According to the literature, PM and DGC along with the VL in Turkish population, were not used previously for sex determination from the scapula. A combination of the VL and PM was found to be the most effective parameters at sex determination from scapula in the Turkish population. There are few studies on the sex determination from scapula in the Turkish population. This study will guide anthropologists, forensic scientists and anatomists at sex determination studies from scapula and surgeons by morphometrically in clinical situations related to the scapula.

RESUMEN: El objetivo de este estudio fue contribuir a la determinación del sexo a partir de la escápula en la población turca y comparar con estudios previos. Esta investigación se realizó con 200 escápulas (100 hombres y 100 mujeres). El rango de edad de los pacientes estaba entre de 18 años y 93 años. Escaner de tomografía computada se usó para medir en la cavidad glenoidea los siguientes parámetros: longitud (LCG), ancho (ACG), profundidad (PCG), perímetro (PG) y volumen (VCG). Se midieron 20 escápulas seleccionadas tres veces al azar para examinar la confiabilidad intraevaluador de estas mediciones. Se realizó un análisis de regresión logística de género para encontrar las variables significativas en la determinación del sexo a partir de la escápula. El parámetro más eficaz para determinar el sexo a partir de la escápula resultó ser VCG (88,5%). Los efectos de LCG, PG, ACG y PCG en la determinación del sexo a partir de la escápula fueron del 83 %, 82,5 %, 79,5 % y 66 %, respectivamente. La combinación de VCG y PG (89,5%) resultó ser la combinación más efectiva en la determinación del sexo a partir de la escápula. Se encontró que los valores de correlación intraclase de todas las mediciones tenían una alta confiabilidad. De acuerdo con la literatura, PG y PCG junto con el VCG en la población turca, no se han utilizado previamente para la determinación del sexo a partir de la escápula. Se determinó que una combinación de VCG y PG son los parámetros más efectivos en la determinación del sexo a partir de la escápula. Existe escasa información sobre la determinación del sexo a partir de la escápula en la población turca. Este estudio guiará a los antropólogos, forenses y anatomistas en los estudios de determinación del sexo de la escápula y sera útil para los cirujanos en situaciones clínicas relacionadas con la escápula.

Determination of Dimensions of Glenoid Cavity from other Scapular Parameters in North Indian Population

Background: The Glenoid cavity dimensions can help to predict the incidence of glenohumeral dislocations in a population. Purpose of study: The present study involved the measurements of the body of the scapula and the glenoid cavity and to draw the relationship of them to predict the chances of glenohumeral dislocations in North Indian Population. Methods: A total number of 130 adult scapulae of unknown sex showing complete ossification and without any damage were included in the study. The various shapes of glenoid cavities both on right and left sides were noted and analysed. A digital Vernier calliper was used to measure all the dimensions of scapula as well as glenoid cavity. The data was analysed and regression formulae to estimate the glenoid cavity dimensions were drawn. Results: Most common shape of the glenoid cavity in the present study was pear shaped (52.30%) followed by inverted comma shaped (33.07%) and least common was oval shaped (14.63%). Mean maximum height of scapula (MSH) was 142.45± 2.32 mm, mean maximum width of scapula (MSW) was 102.65± 0.21mm. Mean maximum glenoid height (MGH) was 38.77± 3.15mm, mean maximum glenoid width I (MGW I) was 23.82± 2.11 mm, mean maximum glenoid width II ( MGW II) was 14.78± 9.11mm. Mean scapular index (SI) was 71.32± 0.61(60-<73) % and mean glenoid index (GI) was 60.43± 5.43%( 60-69%). Bilateral differences in these parameters were statistically insignificant. Mean maximum scapular height was significantly correlated with both mean maximum glenoid height and mean maximum glenoid width. There was also found highly significant interglenoid dimension correlation. Conclusion: Glenohumeral dislocations are expected if indices are <50% or > 89%. A deviation from the normal relation between maximum glenoid width and maximum glenoid length also indicates glenohumeral instability.

Arthroscopy Limits on Anterior Shoulder Instability / Limites da artroscopia na instabilidade anterior do ombro

Abstract Much is discussed about the limits of the treatment of anterior shoulder instability by arthroscopy. The advance in understanding the biomechanical repercussions of bipolar lesions on shoulder stability, as well as in the identification of factors related to the higher risk of recurrence have helped us to define, more accurately, the limits of arthroscopic repair. We emphasize the importance of differentiation between glenoid bone loss due to erosion (GBLE) and glenoid edge fractures, because the prognosis of treatment differs between these forms of glenoid bone failure. In this context, we understand that there are three types of bone failure: a) bone Bankart (fracture); b) combined; and c) glenoid bone loss due to anterior erosion (GBLE), and we will address the suggested treatment options in each situation. Until recently, the choice of surgical method was basically made by the degree of bone involvement. With the evolution of knowledge, the biomechanics of bipolar lesions and the concept of glenoid track, the cutoff point of critical injury, has been altered with a downward trend. In addition to bone failures or losses, other variables were added and made the decision more complex, but a little more objective. The present update article aims to make a brief review of the anatomy with the main lesions found in instability; to address important details in arthroscopic surgical technique, especially in complex cases, and to bring current evidence on the issues of greatest divergence, seeking to guide the surgeon in decision making.

Resumo Muito se discute sobre os limites do tratamento da instabilidade anterior do ombro por artroscopia. O avanço no entendimento das repercussões biomecânicas das lesões bipolares sobre a estabilidade do ombro, bem como na identificação de fatores relacionados ao maior risco de recidiva têm nos ajudado a definir, de forma mais apurada, os limites do reparo por via artroscópica. Ressaltamos a importância de diferenciação entre perda óssea por erosão da glenoide (POAG) e fraturas da borda da glenoide, pois o prognóstico do tratamento diverge entre essas formas de falha óssea da glenoide. Neste contexto, entendemos que há três tipos de falha óssea: a) Bankart ósseo (fratura); b) combinada; e c) POAG, e abordaremos as opções de tratamento sugerido em cada situação. Até há pouco tempo, a escolha do método cirúrgico era norteada basicamente pelo grau de acometimento ósseo. Com a evolução do conhecimento, da biomecânica das lesões bipolares e do conceito do glenoid track (trilho da glenoide), o ponto de corte da lesão crítica, vem sendo alterado com tendência de queda. Além das falhas ou perdas ósseas, outras variáveis foram adicionadas e tornaram a decisão mais complexa, porém um pouco mais objetiva. O presente artigo de atualização tem como objetivo fazer uma breve revisão da anatomia com as principais lesões encontradas na instabilidade; abordar detalhes importantes na técnica cirúrgica artroscópica, em especial nos casos complexos, e trazer as evidências atuais sobre os assuntos de maior divergência, buscando guiar o cirurgião na tomada de decisão.

Results of the surgical treatment of articular scapular fractures / Resultados do tratamento cirúrgico das fraturas articulares de escápula

ABSTRACT Introduction: Scapular fractures are rare injuries and are often associated with high-energy trauma, with joint fractures accounting for only 15% of all scapular fractures. Surgical treatment is indicated for fractures with large deviations and with joint instability. Objective: This study evaluates the clinical and functional results after surgical treatment of scapular fractures. Methods: Eight patients with scapular fractures were surgically treated between 2013 and 2019. For indication for surgical treatment, mediolateral deviations, glenopolar angle, angular deviations and joint deviations greater than 4 mm were taken into account. Radiographic results of consolidation, range of motion, functional score and visual analogue pain scale were obtained. Results: In the mean follow-up of twenty-nine months (13-40 months), all patients presented fracture consolidation. The mean UCLA score was 29 points (with 75% good results and 25% moderate results). Regarding the range of motion, the mean elevation was 146° (ranging from 110° to 60°), lateral rotation of 62° (36-80°) and medial rotation at the level of T7 (T6-T10). The final VAS mean was 2.3. All patients returned to the pre-injury level at work. Conclusion: In this series of cases, surgical treatment of scapular articular fractures provided satisfactory results with low rates of complications, showing to be an option in selected cases of deviated fractures. Level of Evidence IV, Case Series.

RESUMO Introdução: As fraturas de escápula são lesões raras e muitas vezes associadas a traumas de alta energia, sendo que as fraturas articulares correspondem a apenas 15% de todas fraturas escapulares. O tratamento cirúrgico é indicado para fraturas com grandes desvios e com instabilidade articular. Objetivo: Avaliar os resultados clínicos e funcionais após o tratamento cirúrgico das fraturas de escápula. Métodos: Oito pacientes com fraturas da escápula foram tratados cirurgicamente entre o período de 2013 e 2019. Para indicação do tratamento cirúrgico, levou-se em consideração os desvios mediolaterais, ângulo glenopolar, desvios angulares e desvio articular maior que 4 mm. Resultados radiográficos de consolidação, arco de movimento, escore funcional e escala visual analógica de dor foram obtidos. Resultados: No seguimento médio de 29 meses (13-40 meses), todos os pacientes apresentaram consolidação da fratura. A média do escore UCLA foi de 29 pontos (sendo 75% de resultados bons e 25% de resultados moderados). Com relação ao arco de movimento, a elevação média foi de 146° (variando de 110° a 160°), rotação lateral de 62° (36-80°) e rotação medial no nível de T7 (T6-T10). A média final do EVA foi de 2,3. Todos os pacientes retornaram ao nível pré-lesão de trabalho. Conclusão: Nesta série de casos, o tratamento cirúrgico das fraturas da escápula com envolvimento articular proporcionou resultados satisfatórios com baixa taxas de complicações, mostrando ser uma opção em casos selecionados de fraturas desviadas. Nível de Evidência IV, Série de Casos.

An axillary approach for open reduction and internal fixation to treat anterior glenoid fracture: an anatomical and clinical study / 中华骨科杂志

Objective:To investigate the clinical effect and safety of reduction and fixation for the anterior glenoid fracture through an axillary approach.Methods:Two autopsy specimens (a total of 4 shoulder joints) were used to simulate the surgery of open reduction and internal fixation to treat anterior glenoid fracture through an axillary approach. Specimens were placed in the lateral decubitus position. An incision was made in the posterior axillary line to expose the lateral side of the scapula through the interval ahead of the latissimus dorsi muscle. Attended to the separation and protection of the axillary nerve, posterior humerus artery, thoracic dorsal nerve, and scapular artery. The surgical area of the axillary approach was divided into the upper "quadrilateral area" and the lower "trilateral area", which exposed the anteroinferior glenoid, neck, and the full length of lateral border of the scapula. Thirteen cases (7 males and 6 females) were involved in this study, all patients were diagnosed with anterior glenoid fracture and treated by open reduction and internal fixation through the axillary approach between April 2018 and December 2020. Constant-Murley score and Disabilities of the Arm, Shoulder and Hand (DASH) were used to evaluate the clinical efficacy.Results:Thirteen patients were enrolled for final analysis, which included 12 right cases and 1 left case. The average age was 50.38±13.74 years (range 24-67 years). All 13 patients were classified as Ideberg type Ia fracture. Anatomical buttress plates were used in 5 cases, cannulated screws combined with metacarpal plates in 7 cases, and distal radius plate in 1 case. The average length of follow-up was 13.00±5.97 months (range 6-26 months). No delayed union or malunion in all cases at the last follow-up visits. The average of Constant-Murley score was 62.46±10.26 points (range 45-83) and the DASH score was 27.56±9.76 points (range 14.14-43.33) at the three months follow up visits. At 6 months postoperatively, the Constant-Murley score was 80.85±8.32 points (range 65 to 90) and the DASH score was 11.47±8.56 points (range 0 to 35.00). Constant-Murley score at the final patient's follow-up visit was 84.54±8.95 points (range 70-95), and the DASH score was 10.94±8.67 points (range 1.67 to 33.33 points). The joint function gradually recovered with time. The functional scores at 3 months, 6 months after surgery, and final follow-up visit had significant differences ( P<0.05). Conclusion:The axillary approach is a safe and feasible approach for the treatment of the anterior glenoid fracture. This approach exposes the anteroinferior glenoid and the lateral border of the scapula, which reduces rotator-cuff injury and achieves anatomic reduction and strong fixation of the fracture. The axillary approach surgery also allows early functional physiotherapy after surgery.

Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI / A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

Abstract Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.

Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325-0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.

Glenoid size and orientation in the Chilean population / Tamaño y orientación glenoidea en la población chilena

Glenoid morphology is a key factor in determining the success of shoulder surgery. The purpose of this experimental study was to precisely determine the anatomical size and orientation of the glenoid in the Chilean population. 122 CT scans from asymptomatic Chilean patients were obtained. The mean age was 43.8 years (SD 12.3; range, 17-53 years) with 63 female and 59 male patients. For each of the scapulae, were obtained the glenoid version and inclination, maximum glenoid width and height, superior glenoid width, glenoid surface area, glenoid vault depth, and maximum scapular width. The glenoid size showed an average width of 26 ± 2.7 mm, a height of 40.3 ± 3.5 mm and a vault depth of 26.5 ± 3.7 mm. There were significant differences between men and women. The glenoid orientation showed an average of -13.9 ± 4.8° of retroversion and a superior inclination of 11.1 ± 4.7°. Significant differences between men and women were seen only for version. We conclude, that in this Chilean sample the morphological parameters of the glenoid correspond to the published literature, however, some characteristics in this cohort must be further confirmed using other methods.

La morfología glenoidea es un factor clave para determinar el éxito de la cirugía de hombro. El propósito de este estudio experimental fue determinar con precisión el tamaño anatómico y la orientación de la glenoides en la población chilena. Se obtuvieron 122 tomografías computarizadas de pacientes chilenos asintomáticos. La edad media fue de 43,8 años (DE 12,3; rango, 17-53 años) con 63 pacientes femeninos y 59 masculinos. Para cada una de las escápulas, se obtuvieron la versión glenoidea y la inclinación, el ancho y la altura glenoidea máxima, el ancho glenoideo superior, el área de superficie glenoidea, la profundidad de la bóveda glenoidea y el ancho escapular máximo. El tamaño glenoideo mostró un ancho promedio de 26 ± 2,7 mm, una altura de 40,3 ± 3,5 mm y una profundidad de bóveda de 26,5 ± 3,7 mm. Hubo diferencias significativas entre hombres y mujeres. La orientación glenoidea mostró un promedio de -13,9 ± 4,8 ° de retroversión y una inclinación superior de 11,1 ± 4,7 °. Se observaron diferencias significativas entre hombres y mujeres solo para la versión. Concluimos que en esta muestra chilena los parámetros morfológicos de la glenoides corresponden a la literatura publicada, sin embargo, algunas características de esta cohorte deben confirmarse aún más utilizando otros métodos.

Comparative Evaluation of Coracoid Graft Dimensions in the Latarjet Surgery for Anterior Glenohumeral Instability / Avaliação comparativa das dimensões do enxerto do coracoide na cirurgia de Latarjet para instabilidade glenoumeral anterior

Abstract Objectives The aim of the present study was to describe the dimensions of the coracoid grafts in our Latarjet surgeries and compare them with the results described in the literature. In addition, the feasibility of the 7-millimeter rule was verified. Methods Individuals with anterior glenohumeral instability with or without bone loss participated in the present study. The dimensions of 31 coracoid process grafts of patients who were submitted to the Latarjet surgical technique were measured with an analogical caliper and recorded for posterior analysis. Results The dimensions of the coracoid graft did not show statistically significant differences related to gender. The graft width obtained from our sample presented similarities with the dimensions reported in the literature. However, the length and thickness were smaller when compared to the reference study (Young et al, 2013).15 The 7-millimeter rule was considered feasible regarding the graft dimensions obtained from our sample. Conclusion The coracoid graft dimensions were similar to the dimensions described in the literature regarding width, but the same was not found for length and thickness; and the 7-millimeter rule was feasible regarding the graft dimensions obtained from our sample.

Resumo Objetivo O objetivo deste estudo foi descrever as dimensões do processo coracoide em nossas cirurgias de Latarjet e compará-las com os resultados descritos na literatura. Além disso, a viabilidade da regra dos 7 milímetros foi verificada. Métodos Indivíduos com instabilidade glenoumeral anterior com ou sem erosão óssea participaram deste estudo. As dimensões de 31 enxertos de processo coracoide de pacientes operados pela técnica de Latarjet foram mensuradas com um paquímetro analógico e registradas para análise posterior. Resultados As dimensões do processo coracoide não demonstraram diferença estatisticamente significativa de acordo com o sexo. A largura do enxerto obtida em nossa amostra apresentou semelhança com as dimensões descritas na literatura. No entanto, o comprimento e a espessura foram um pouco menores quando comparados com o estudo de referência (Young et al, 2013).15 A regra dos 7 milímetros foi considerada viável com as dimensões do enxerto obtidas em nossa amostra. Conclusão As dimensões do enxerto do coracoide foram similares às descritas na literatura em relação à largura, mas o mesmo não foi encontrado quanto ao comprimento e espessura; e a regra dos 7 milímetros demonstrou viabilidade com as dimensões do enxerto obtidas em nossa amostra.

Morphological Variations Of Glenoid Cavity Of Human Scapulae: An Anatomical Study With Clinical Relevance

Purpose: The purpose of this present study was to observe the morphological variations of glenoid process ofadult human scapulae by subjective evaluation, because morphologic variants of adult glenoid process play animportant role in various shoulder joint pathologies especially dislocations with fractures of the glenoid cavitywhich is also quite common.Materialsand Methods: Two hundred sixty adult dry scapulae (127 right & 133 left) from the osteology museumof department of Anatomy, belonging to Indian population of unknown sex & age were obtained for the morphologicpattern of glenoid cavity by subjective evaluation. We have examined the presence of notch in the glenoidprocess of each scapulae& according to the presence of notch, we evaluated the bones for the morphologicalclassification as pear; inverted comma & oval shaped glenoid process. Our observations were compared withother osteological studies performed on different other population groups.Results: Out of total 260 scapulae, 187 bones showed notch in the margin of the glenoid cavity.Most of the boneswithout a notch were termed as oval shaped (73 scapulae) glenoid & rest of the bones were of pear shapedvariety. Among the pear shaped glenoid, 113 scapulae showed pear shaped cavity with slight notch; 71 scapulaeshowed an inverted comma shaped glenoid. Not only the basic morphology, we have also reported some of thescapulae with special morphologic features like a very prominent infraglenoid tubercle; presence of foramen inthe glenoid cavity &highly special nodular glenoid cavity.Conclusions: Though glenoid cavities showed highly variable morphological pictures, but the clinicians shouldbe well versed with the normal appearance & anatomic variants of glenoid cavities on dry bones, so that they caninterpret its morphology on radiographs and MRI scans. Our results of this subjective evaluation may be of helpas baseline data for theclinicians especially for the orthopaedic surgeons for the diagnosis &treatment modalitiesof shoulder dislocations & fracture.

Morphologic and morphometric analysis of glenoid cavity of human scapula

Background: To study the morphometry and morphology of glenoid cavity of dried scapula bone and in CT scan of glenoid cavity. The present study aimed at calculating three dimensions i.e. vertical diameter, horizontal diameter of the upper segment and horizontal diameter of the lower segment of the glenoid cavity and describing the incidence of its different shapes.Methods: This study was done on 100 dry, unpaired adult human scapulae of unknown sex. 50 scapulae belongs to right side and 50 scapulae belongs to left side obtained from Department of Anatomy, SRM Medical College and Research Institute. The above mentioned diameters are measured using Vernier caliper and the mean dimensions are calculated, morphological variations are studied. 3D CT images of scapulae, obtained from Department of Radiology, SRM Medical college and Hospital, Potheri, were also analysed.Results: In the current study, various dimensions and incidence of various shapes of glenoid cavity were measured. The incidence of both pear and inverted comma shape in right side is greater than in left whereas the incidence of oval shape in left side is greater than right side. The SI diameter of right glenoid is greater than the left, which is statistically significant. The Antero-posterior diameters (AP-1, AP-2, AP-3) of right glenoid is greater than the left, but not statistically significant.Conclusions: The knowledge of the above said variations of glenoid cavity is important in manufacturing the glenoid component of shoulder prosthesis, repair of Bankart’s lesion, procedures like posterior glenoid osteotomy.

Morphometry And Morphology Of Glenoid Cavity Of Scapula

Introduction: The Glenoid cavity is regarded as the head of the scapula. The morphology of glenoid cavity ishighly variable. It articulates with the head of the humerus at the glenohumeral joint. Shape and dimensions ofthe glenoid cavity are important in the design and fitting of glenoid components for total shoulder arthroplasty.An understanding of variations in normal anatomy of the glenoid is essential while evaluating pathologicalconditions like osseous bankart lesions and osteochondral defects. The aim of the present study was to obtainthe anthropometric data of the glenoid cavity of the scapula and to study the various shapes of the glenoid cavitywhich will help in management of shoulder pathology.Materials and Methods: This study was done on 74 dry, unpaired adult human scapulae (36 right side and 38 leftside )of unknown sex belonging to the saurashtra population. Maximum superior-inferior diameter and Maximumanterior-posterior diameter of the glenoid cavity were measured and. The shape of the glenoid cavity wasclassified as inverted comma shaped, pear shaped and oval shaped depending upon the presence or absence ofa notch on the glenoid rim.Results: The average SI diameter on right and the left sides were 38.49 ± 3.17mm and 38.06 ± 3.34mm respectively.The average AP-1 diameter of the right glenoid were 24.76±2.49mm and that of the left was 24.23 ± 2.14mm.Themean AP-2 diameter of the right glenoid was 18.83±2.19 mm and that of the left was 17.97±2.08.Conclusion: These findings suggest that the difference in size of the glenoid cavity in Gujarati population mayhave to be taken into consideration while deciding the size of the glenoid component in shoulder arthroplasty inthis population.

The efficacy of SLAP repair and biceps tendon tenotomy and fixation for type Ⅱ SLAP lesions in shoulder arthroscopic:a Meta-analysis / 中华骨科杂志

Objective To evaluate the effects of SLAP repair and biceps tendon tenotomy and fixation in treating type Ⅱ superior labrum from anterior to posterior in shoulder arthroscopy.Methods PubMed,CNKI,VIP,and Wanfang database were searched electronically to screen randomized controlled trials and non randomized controlled trials that comparing two surgical methods for type Ⅱ SLAP lesions.In addition,we also retrieved the domestic orthopedic magazine and searches references that we had included in the present study.According to the criterion,screening literatures,data extraction and quality assessment were conducted by two reviewers independently.Meta-analysis was performed by using RevMan 5.3 software to evaluate UCLA scores,ASES scores,VAS scores and SST scores.Results A total of 7 articles were included in the present study,including 3 literatures in Chinese and 4 in English.There were 2 randomized controlled trials and 5 non randomized controlled trials.Two hundred and fifty-six patients were enrolled in the present study,including one hundred and twenty-five patients with SLAP repair and one hundred and thirty-one patients with biceps tendon tenotomy and fixation.Meta-analysis showed that there was significant difference in total score of UCLA [MD=2.55,95％CI(0.57,4.53),P=0.01] and shoulder function in the UCLA scoring system [MD=0.62,95％ CI(0.21,1.02),P=0.003] compared with SLAP repair.There was no difference in the UCLA scoring system,including pain [MD=0.99,95％CI(-0.15,2.14),P=0.09],flexion [MD=0.16,95％CI(0.01,0.32),P=0.06],strength [MD=0.03,95％CI(-0.15,0.22),P=0.74],satisfaction [SMD=0.18,95％ CI(-0.57,0.93),P=0.64] compared with SLAP repair.There was significant difference in ASES scores [MD=6.32,95％CI(2.55,10.08),P=0.001] between two groups.There was no difference in VAS scores [MD=0.54,95％CI (-0.64,1.72),P=0.37] and SST scores [MD=0.81,95％CI(-0.23,1.86),P=0.13] between two groups.Conclusion The UCLA scores,ASES scores and surgical results of biceps tendon tenotomy and fixation are superior to SLAP repair in treating type Ⅱ SLAP lesions.However,there is no significant advantage in pain,flexion,strength and satisfaction between the two groups.

Cambio de posición del cóndilo dentro de la cavidad glenoidea en pacientes clase ii esqueletal con mordida profunda / Change of position of condyle within glenoidal cavity in patientsclass II skeletal with deep bite

Objetivo: El propósito de esta investigación es determinar el cambio de posición del cóndilo dentro de la cavidad glenoidea en pacientes clase II Esqueletal con mordida profunda después de la utilización de un plano de mordida anterior fijo acrílico y metálico. Materiales y Métodos: Se tomará una muestra del 20% de un universo de 100 pacientes de Clínica de la Escuela de Postgrado de la Facultad de Odontología de la Universidad de Guayaquil para demostrar los cambios que se producen en la articulación temporomandibular como consecuencia de la nueva posición adoptada por el cóndilo debido a la nueva postura mandibular por el uso del plano de mordida. Estos pacientes serán evaluados a través de radiografías cefalométricas que serán tomadas en el transcurso del uso de los planos de mordida anterior hasta el momento que se ha conseguido el contacto del segmento posterior de las piezas dentarias donde se tomará en consideración el cambio de posición del cóndilo y de esta manera determinar la estabilidad que se desea conseguir en el tratamiento. Resultados: Todos los pacientes que utilizaron plano de mordida anterior metálico obtuvieron en el 100% el cambio de posición del cóndilo mandibular, llegando a la norma de 32+-2; mientras que el 69,23% de los pacientes que utilizaron el plano de mordida anterior acrílico tuvieron un cambio positivo y el 30,77% fue negativo. Conclusiones: Por lo tanto se concluye que con el plano de mordida anterior metálico se obtiene mayor exactitud en el cambio de posición del cóndilo mandibular.

The purpose of this investigation is to determine the change of position of the condyle within the glenoid cavity in class II patients with deep bite after the use of a fixed anterior Acrylic and Metallic bite plane, which will be done with a sample of the 20% of a universe of 100 patients from Clinic of the Postgraduate School of the Faculty of Dentistry of the University of Guayaquil to demonstrate the changes that occur in the temporomandibular joint resulting from the new position adopted by the condyle due to the new mandibular posture by the use of the bite plane. These patients will be evaluated through cephalometric radiographs that will be taken in the course of the use of the anterior bite planes until the contact of the posterior segment of the dental pieces has been achieved where the change of position of the condyle will be taken into account And thus determine the stability to be achieved in the treatment. The results that presented the patients in the change of position of the mandibular condyle that they used plane of previous bite Metallic was positive in 100% of them, arriving at the norm of 32 + -2; While 69.23% of patients who used the anterior acrylic bite plane had a positive change and 30.77% were negative; Therefore it is concluded that with the Metallic anterior bite plane, greater accuracy is obtained in the position change of the mandibular condyle.

Extension of a Scapular Fracture into the Glenoid Cavity after Low-voltage Electric Shock

We, herein, present a patient with no history of trauma who developed shoulder pain after undergoing low-voltage electric shock. According to the computed tomography, there was a multi-segmental fracture that extended into the glenoid cavity of the left scapula. A good outcome was obtained after open reduction and internal fixation. Emergency physicians should be aware of the possibility of scapular fracture extending into the glenoid cavity, especially in patients with shoulder pain after electrical injury.

Arthroscopic-assisted Reduction and Percutaneous Screw Fixation for Glenoid Fracture with Scapular Extension

BACKGROUND: To evaluate the clinical and functional outcomes of arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension, and investigate the radiologic and clinical benefits from the results. METHODS: We evaluated patients treated with arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension from November 2008 to September 2015. Fractures with displacement exceeding one-fourth of the anterior-articular surface or more than one-third of the posterior-articular surface in radiographic images were treated by surgery. Clinical assessment was conducted based on range of motion, Rowe score, and Constant score of injured arm and uninjured arm at last follow-up. RESULTS: Fifteen patients with Ideberg classification grade III, IV, and V glenoid fracture who underwent arthroscopic-assisted reduction using percutaneous screw fixation were retrospectively enrolled. There were no differences in clinical outcomes at final follow-up compared to uninjured arm. Bone union was seen in all cases within five months, and the average time to bone union was 15.2 weeks. Ankylosis in one case was observed as a postoperative complication, but the symptoms improved in response to physical therapy for six months. There was no failure of fixation and neurovascular complication. CONCLUSIONS: We identified acceptable results upon radiological and clinical assessment for the arthroscopic-assisted reduction and percutaneous fixation. For this reason, we believe the method is favorable for the treatment of Ideberg type III, IV, and V glenoid fractures. Restoration of the articular surface is considered to be more important than reduction of fractures reduction of the scapula body.