Scapular neck fracture - the influence of permanent malalignment of the glenoid neck on clinical outcome

Citation
J. Romero et al., Scapular neck fracture - the influence of permanent malalignment of the glenoid neck on clinical outcome, ARCH ORTHOP, 121(6), 2001, pp. 313-316
Citations number
18
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine
Journal title
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN journal
0936-8051 → ACNP
Volume
121
Issue
6
Year of publication
2001
Pages
313 - 316
Database
ISI
SICI code
0936-8051(200106)121:6<313:SNF-TI>2.0.ZU;2-L
Abstract
A scapular neck fracture is considered unstable if it is associated with an ipsilateral clavicular fracture or an acromioclavicular (AC) joint disloca tion. Currently, it is recommended that stabilization of a disrupted should er girdle must be achieved through open reduction and internal fixation of the clavicular fracture or by reduction of the AC joint, without addressing the scapular neck. However, if the displaced glenoid neck is not simultane ously reduced, malalignment of the glenoid neck may persist. The purpose of this retrospective study was to analyze the effect of associated shoulder girdle injury on glenoid displacement and the influence of glenoid malalign ment on clinical outcome. Nineteen patients with scapular neck fractures we re reviewed clinically and radiologically at a mean of 8 years (range 2-21 years) after injury. None of them has developed nonunion of the scapular ne ck, and only one showed radiological signs of mild degenerative joint disea se. The glenopolar angle (GPA), which assesses the rotational malalignment of the glenoid about an anteroposterior axis perpendicular to the scapular plane on plain X-rays was measured less than 20 degrees in six patients. Th ree of them had sustained an associated clavicular fracture or AC joint dis location. The other 3 patients had permanent severe malalignment of the gle noid neck in the absence of an associated shoulder girdle injury. Five pati ents with GPA less than 20 degrees complained of moderate or severe pain, w hereas of the 13 patients with mild or no glenoid rotational displacement o r medial displacement alone, 11 patients had no or mild pain, and only 2 ha d moderate or severe pain (P = 0.0095). Five patients presented with reduce d activities of daily living, 4 of them had severe glenoid rotational displ acement (P = 0.0173). Loss of motion was found in only 2 patients, and both had a severely displaced glenoid neck (P = 0.088). In conclusion, severe d isplacement of the glenoid neck may occur with or without associated fractu re of the clavicle or dislocation of the AC joint and can be identified as a GPA less than 20 degrees. Scapular neck fractures with such malalignment have a less favorable long-term outcome compared with otherwise comparable cases with absence of glenoid malalignment as measured with the glenopolar angle.