Manejo quirúrgico de fracturas extraarticulares de la escápula. Reporte de caso y revisión de literatura / Surgical treatment of an extraarticular scapula fracture. Case report and literature review

Resumen: Introducción: Las fracturas escapulares comprenden 1% del total de las fracturas en general y de 3 a 5% del hombro, las cuales se presentan por alta energía en pacientes jóvenes. Sólo 10% tiene indicación quirúrgica al tomarse como base la alteración de complejo suspensorio del hombro. El objetivo es valorar el resultado de pacientes con indicación quirúrgica así como una revisión de la literatura. Reporte de casos: Presentamos dos pacientes con fractura del cuerpo escapular derecho Bartonicek D con desplazamiento mediolateral, deformidad angular anteroposterior y alteración del ángulo glenopolar. Se realizó el manejo quirúrgico con osteosíntesis y placas convencionales y anatómicas. Se realizó valoración funcional y seguimiento radiográfico de ambos casos a los seis meses y se obtuvo arcos de movilidad flexión 180o/170o en ambos casos, así como escalas funcionales DASH 22/25, Constant 90/89 y Simple Shoulder Test 11/11 respectivamente; se obtuvo una consolidación ósea grado III-IV de Montoya. Discusión: Se considera importante realizar una adecuada reducción y estabilización del trazo de fractura debido al bajo grado de satisfacción con tratamiento conservador en pacientes con alta demanda funcional, que consiste en dolor residual, pinzamiento y disquinesia escapular. Se recomienda la cirugía para estas fracturas ya que comprometen la cadena cinética del hombro e impactan en el resultado funcional a corto y mediano plazo.

Abstract: Introduction: Scapular fractures comprise 1% of all fractures and 3 to 5% of the shoulder, they occur in young patients by high energy trauma. Only 10% have surgical indication based on the alteration of the shoulder's suspensory complex. The objective is to assess the outcome of patients with surgical indication as well as a review of the literature. Case report: We present two patients with Bartonicek D fracture of the right scapular body with mediolateral displacement, anteroposterior angular deformity and alteration of the glenopolar angle. Surgery was performed on both cases with conventional and special anatomical plates. Functional assessment and radiographic follow-up of both cases were performed at 6 months, obtaining flexion mobility of 180º/170º in both cases, as well as functional scales DASH 22/25, Constant 90/89 and Simple Shoulder Test 11/11 respectively; with bone consolidation grade III-IV of Montoya. Discussion: Due to the low degree of satisfaction with conservative treatment in patients with high functional demand, and multiple complications consisting in residual pain, impingement and scapular dyskinesia; it is important to perform an adequate reduction and stabilization of the fracture. We recommend surgical management for this type of fractures since they compromise the kinetic chain of the shoulder and impact the functional outcome in the short and medium term.

Comparative study of surgical treatments of scapula fracture through the muscle space of rotator cuff approach and Judet approach / 中国修复重建外科杂志

Objective: To study the surgical treatments of scapula fracture through the muscle space of rotator cuff approach and the Judet approach, and to evaluate and compare the clinical results. Methods: Between January 2014 and December 2015, 50 patients with scapula fractures were treated with open reduction and internal fixation of reconstruction plate. Twenty-four patients were treated through the muscle space of rotator cuff approach (group A), and 26 patients were treated through the Judet approach (group B). There was no significant difference in gender, age, cause of injury, type of fracture, and the interval between injury and operation ( P>0.05). The operation time, intraoperative blood loss, and incision length were recorded, and the shoulder functions after fracture healing confirmed by X-ray films were evaluated according to the Hardegger's scoring system. Results: The operation time, intraoperative blood loss, and incision length in group A were significantly lower than those in group B ( P < 0.05). The incisions of the two groups healed by first intention. All patients were followed up 6-13 months (mean, 11.6 months) in group A and 7-15 months (mean, 12.1 months) in group B. According to Hardegger standard, the effectiveness was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case, with the excellent and good rate of 95.8% in group A, and as excellent in 15 cases, good in 4 cases, fair in 5 cases, and poor in 2 cases with the excellent and good rate of 73.1% in group B. The difference in effectiveness between 2 groups was significant (χ 2=4.81， P=0.03). X-ray films showed that the reduction and internal fixation were satisfied and the fractures healed in 2 groups. The fracture healing time were (29.86±8.38) weeks in group A and (30.05±7.99) weeks in group B, showing no significant difference between 2 groups ( t=0.16, P=0.87). Conclusion: Compared with the Judet approach, the muscle space of rotator cuff approach has advantages of clearly exposure, less muscular dissection, less intraoperative blood loss, less operation time, easier operation, and satisfied shoulder function can be obtained.

Intramedullary devices in the management of Judet III and IV paediatric radial neck fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The aim of this study is to discuss the results of different intramedullary devices used in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique.</p><p><b>METHODS</b>Thirty patients with isolated Judet III and IV fractures were included in this prospective study. Judet I and II fractures and radial neck fractures associated with other injuries were excluded. The final results were graded using the Metaizeau functional scoring system and Oxford Elbow Score.</p><p><b>RESULTS</b>The functional result was good to excellent in 24 of 30 cases (80%). The mean Oxford Elbow Score was 44.32. The mean follow-up was 40.11 months. The complications seen were radiocapitellar joint penetration - 6 cases at mean 4.87 weeks, redisplacement - 6, radial epiphyseal sclerosis - 5, and heterotopic ossification - 1 case.</p><p><b>CONCLUSION</b>Intramedullary K wires may result in radiocapitellar joint penetration. Titanium Elastic Nail System should not be used as purely fixation devices as they may not prevent redisplacement. Regular follow-up until at least 6 weeks is essential. Patients who have a Judet IV fracture and need open reduction should be given a guarded prognosis. The paper highlights the pitfalls of the technique and makes recommendations regarding the type of implant, follow-up and patient counselling in Judet IV fractures.</p>

The clinical effects of straight incision in the treatment of scapular neck and body fractures / 中国基层医药

Objective To evaluate the clinical effect of straight incision in the treatment of scapular neck and body fractures .Methods 62 cases with scapular neck and body fractures were randomly divided into the obser -vation group (30 cases) and control group (32 cases).The control group was given the traditional Judet approach operation,the observation group was given the straight incision operation .The general situation of operation ,fracture healing time ,clinical efficacy and postoperative complications were observed .The improvement of joint function after operation was evaluated .Results The operation incision ,operation time and intraoperative blood loss of the observa-tion group were significantly better than those of the control group (t=9.599,9.506,21.297,P<0.01).The fracture healing time between two groups had no statistically significant difference (t=0.922,P=0.35).The effective rate of fracture healing in the observation group was 93.3%,which was significantly higher than 71.9%of the control group (χ2 =4.885,P<0.05).The incidence rate of complication in observation group was 13.3%,which was lower than 37.5%in the control group(χ2 =4.723,P<0.05).The score of daily activities in observation group was better than the control group(t=3.761,P<0.01).Conclusion The straight incision operation is more minimally invasive in the treatment of scapular neck and body fractures compared with Judet approach ,and it has better prognosis .

Treatment of Stiff Knee

PURPOSE: In this study, the effect arthroscopic adhesiolysis and the need for additional quadricepsplasty were evaluated by reviewing the patients 'data. MATERIALS AND METHODS: From July 1996 to January 2002, 18 patients received operation for the stiff knee. The patients were classified into 2 groups according to treatment method - Group 1: arthroscopic adhesiolysis and Group 2: arthroscopic adhesiolysis plus Judet quadricepsplasty. The Judet quadricepsplasty was performed when maximal knee flexion was not achieved over 90 degree even after arthroscopic adhesiolysis. We reviewed primary causes and the duration of contracture of stiff knee. Preoperative, postoperative, and final range of motion was evaluated. RESULTS: Preoperative, postoperative, and final range of motion was evaluated. In group 1, the average range of motion was 34 degree preoperatively, 107 degree intraoperatively, and 103 degree at the last follow-up. In group 2, the average range of motion, 26 degree preoperatively, 67 degree (after arthroscopic adhesiolysis)-115 degree(after quadricepsplasty) intraoperatively, and 112 degree at the last follow-up. CONCLUSION: Arthroscopic adhesiolysis has an effect in releasing intrarticular adhesion. Additional quadricepsplasty should be considered when the duration of contracture is over 12 months and primary causes of stiff knee is distal femur fracture which causes damages in the quadriceps muscle.

Quadricepsplasty using Judet Technique for Stiffness of the Knee

PURPOSE: The purpose of this study is evaluating the result of Judet's technique of quadricepsplasty for the treatmeot of the stiffness of the knee. MATERIALS AND METHODS: We analysed 30 patients performed Judets quadricepsplasty for extension contracture after trauma. The mean age was 36.6 years, mean follow-up period was 48 months. The cause of contracture was 26 fractures around knee, and non-articular fractures were 4 femoral shaft fractures with infection. The mean period from trauma to quadricepsplasty was 37 months. Clinical analysis was evaluated by Judet's criteria. According to joint involvement, we divided to group A and group B, and group I and group II by period of knee joint immobilization after trauma. RESULTS: According to Judet's criteria, excellent were 14 cases, good 11 cases, and fair 5 cases. The mean preoperative flexion contracture was 6 degree, and final was 1.5 degree. We gained 4.5 degree of flexion contracture. The mean preoperative further flexion was 45 degree, and final was 105.5 degree. So we gained 60.5 degree of further flexion. There was no statistically significant difference according to the joint involvement. There was difference according to immobilization period, but no statistically significant difference. CONCLUSION: Judet's quadricepsplasty and arthrolysis was effective technique for stiffness of the knee, We analysed the effect of joint involvement and immobilization period until quadricepsplasty, but there was no significant statistically different effect.

A Clinical Study of Judet Plate Fixation for Subtrochanteric Fractures of the Femur / 대한정형외과학회잡지

Fractures in the subtrochanteric region of the femur present more formidable problems in treatment than do other trochanteric fractures, because such severe stresses exit at the fracture site. Therefore, as a rule we prefer to treat subtrochanteric fractures by operative means if possible. Many internal fixation devices have been recommanded for use in subtrochanteric fractures and each of these devices have advantages in certain types of subtrochanteric fractures, and their selection should be based on the individual fracture anatomy. A total of 20 patients with fracture of the subtrochanteric region of the femur, who were treated by internal fixation with Judet plate between January 1982 and December 1988 have been reviewed. Our conclusions were as follows; 1. Average age was 38 years old and most common cause of injury was traffic accident. 2. Cast immobilization was done after Judet plate fixation. Partial weight bearing ambulation was enabled from POD 10 weeks and full weight bearing ambulation was enabled from POD 16 weeks. 3. 18 in 20 cases, primary bony union was happened and the mean duration of radiological bony union was 24 weeks. 4. 3 cases of complications, metal failure with refracture (2 cases) and screw loosening (1 case), were occured due to early weight bearing in the post operative course. 5. Judet plate fixation was gave satisfactory result in uncomminuted subtrochanteric fracture, especially Seinsheimer's type I, II-A,B,C or Fieldings type I, II. 6. From a consideration of these series, Judet plate showed easy to use, perfect adaptation and rigid fixation. We thought Judet plate is one of a good implants for rigid fixation of subtrochanteric fracture without severe medial cortical disruption.

Quadricepsplasty for the Extension Contracture of the Knee / 대한정형외과학회잡지

We analyzed 34 extension contracture of the knee patients after modified Judet's procedure. Male patient was 32 and female was 2. Age ranged from 19 years to 61 years average being 34 years old. Follow-up period ranged from 12 months to 7 years and 8 months average being 3 years 8 months. 1. The extension contracture of the knee were due to not only scarring of the vastus intermedius but contractures of quadriceps muscles, and finally did lead to intraarticular adhesion in all cases. 2. The results of modified Judet's procedure were excellent or good in 97% and we concluded that the modified Judet's procedure of quadricepsplasty was good method of treatment in extension contracture of the knee. 3. The extension lag after modified Judet's procedures was increased initially but overcame by physical therapy, and did not significantly increase even after release of rectus femoris. 4. Modified Judet's procedure was able to permit early physical therapy without any skin problem.