Study on the movement of the scapula during elevation of the arm

To clarify the shoulder movement, changes of the tilting angle of the scapula were elevated radiographically in three dimensions during arm elevation. Utilizing data of the tilt of the glenoid fossa against the plane of scapula measured in dry bones, the direction of the glenoid fossa during arm elevation in living subjects was evaluated. The medial tilting angle was nearly constant at about 40 degrees from the resting position to an elevation of the arm to 150 degrees position. The average downward tilt was 12.46 degrees in the resting position; thereafter it gradually tilted backward. Horizontal tilt of the glenoid fossa following arm elevation was 46.15 degrees in the resting position, 46.15 degrees at 90 degrees of elevation, 38.79 degrees at 150 degrees of elevation, and 33.0 degrees at maximum elevation. These findings suggest that the "scapular plane" is the plane 40 degrees against the frontal plane in the range from 0 degrees to 150 degrees elevation of the arm, and that "zero position" is at 150 degrees elevation position in the scapular plane.     

Vascularized bone transfer of scapula apophysis

The vascularized bone transfer of the scapular apophysis was described for the first time by Gilbert and Téot (1982) [1]. The growing pattern of this specific apophysis has large capacity and the plasticity during remodeling is unique. Primarily used for mandibular reconstruction, the scapular crest is also suitable for humeral or femoral reconstruction as well as for carpal stabilization in radial hand malformation, which is considered to be the main clinical indication. The radial hand malformation is characterized by an insufficient ulnar carpal stabilization which leads to luxation and radial deviation of the carpus. Using the vascularized scapular transfer in volar apposition to the ulnar, it enables enlarging the contact surface area with the carpus, thus stabilizing the wrist. Due to the preserved epiphyseal vascularization, good remodeling and integration of the scapular crest is achieved until consolidation takes place.     

Distortion and movement of the expander during skin expansion.

Distortion and movement of tissue expanders can cause expansion of the wrong area, such as the naevus or the scar that is to be resected. In 71 rectangular expanders, we examined the incidence of distortion (over 15 degrees) and movement (over 3 cm). We divided the expanders into three anatomical site groups: scalp, body, and extremities, and compared the complication rate between two study groups (distortion or movement, or not). In total, the incidence of distortion was 15/71 (21%) and that of movement 5/71 (7%). Distortion occurred mainly in the extremities (11/33,33%). The implanted expanders tended to move more often in the body part (3/15, 20%). In the extremities, the bigger the angle between the axis of the implanted expander and that of the extremity, the bigger the angle of distortion. Although the incidence of complications between the two groups was not significant, except for alteration in design of the flap, we recommend that these points should be considered when preoperative plans are being made for appropriate patients.     

Unicameral bone cyst in the scapula of an adolescent

Unicameral bone cysts of the scapula have been reported mainly in adult patients. The atypical location of the unicameral bone cyst in a 12-year-old girl presented a diagnostic dilemma. Curettage proved to be an effective method for both diagnosis and treatment of this benign lesion.     

Relative movement of the navicular bone during normal walking.

The purpose of this study was to determine the pattern and magnitude of navicular bone (NB) movement during walking as well as the relationship between dynamic NB and rearfoot movement. The angle of rearfoot and displacement of the NB was recorded in 106 subjects using the 6D Research electromagnetic tracking system. The relative change in the height of the NB between foot flat and heel-off was 7.9 mm. The NB seems to undergo significant vertical as well as medial displacement during the stance phase of normal walking. This motion is also correlated with rearfoot motion during walking.     

An unusual presentation of a simple bone cyst in the scapula

A 38-year-old man presented with pain in the left shoulder following a fall. A rotator cuff tear was suspected but roentgenograms revealed a lytic, expanded, multiseptate lesion of the scapula adjacent to glenoid. This was compatible with a giant cell tumor, aneurysmal bone cyst or simple bone cyst. The MRI showed rim enhancement and clinched the diagnosis of simple bone cyst. An infraspinous approach to scapula was undertaken and open biopsy confirmed the diagnosis of simple bone cyst. Definitive treatment in the form of curettage and calcium phosphate cementation was carried out. The postoperative period was uneventful. Early mobilization was started. Patient remained well on follow-up and has returned to work in a physically demanding capacity.     

肩胛骨骨巨细胞瘤1例

骨巨细胞瘤是常见的原发性骨肿瘤之一,起始于骨髓内间叶组织,原发部位几乎都发生在长管状骨干骺端,原发于肩胛骨极为少见。1病例资料患者,男,33岁。因右肩肩胛骨肿块7个月入院。无明显诱因及症状,无家族病史。查体:一般情况良好,发育正常,营养中等,无明显消瘦,双上肢前屈、后伸     

Histomorphometric study of bone reactions during orthodontic tooth movement in rats

The biological response to orthodontic tooth movement has generally focused on reactions within the periodontal ligament (PDL), whereas less attention has been paid to the behavior of neighboring bone. The purpose of the study was to describe the influence of orthodontic force on bone surrounding the displaced tooth and the adjacent, untreated teeth. Bone changes in relation to treatment time and different sites were investigated. A mesial tipping of the left maxillary first molar was obtained from 54 adult male Wistar rats. Oxytetracycline was injected subcutaneously 48 h before killing, which took place after 4, 7, or 14 days. The maxilla was fixed in paraformaldehyde and embedded undecalcified in methylmethacrylate. A set of thick horizontal sections was taken from the cervical, intermediate, and apical levels of the roots. The sections were microradiographed and analyzed microscopically under bright-field and fluorescent illumination. Bone fraction and PDL width was measured using a Zeiss Videoplan device equipped with an overlay system. New bone formation was detected by oxytetracycline labels. The analysis showed a consistent, significant decrease of the alveolar bone fraction around both displaced and adjacent teeth at all treatment times. Apposition, indicated by the tetracycline uptake, was found on the periosteal side of the treated hemimaxilla and, after 14 days, also on the surface toward which the tooth was moving and around the adjacent teeth. These results suggest that a time rather than a space relationship exists between bone resorption and formation and that the whole hemimaxilla reacts to the mechanical challenge, resembling the regional acceleratory phenomenon (RAP) observed in other circumstances.     

肩胛骨恶性骨肿瘤微波灭活的临床研究

目的 探讨采用微波对肩胛骨原发恶性肿瘤及转移瘤进行原位灭活,保持肩胛骨完整性的可行性和疗效.方法 1998年6月至2008年2月对累及肩胛骨的17例原发恶性骨肿瘤及转移瘤患者采用微波原位灭活进行治疗.男12例,女5例;年龄13～59岁,平均48岁.肿瘤类型:原发恶性骨肿瘤12例,转移瘤5例.肿瘤部位:14例累及S1区,3例转移瘤同时累及S1和S2区.17例全部采用肩胛骨背侧人路,根据肿瘤累及区域采用弧形或"口"形切口暴露肿瘤,周围软组织在铜网保护下,用2450MHz微波将肿瘤局部温度加热到50℃,持续20 min,然后全部或部分剥离坏死肿瘤组织,保留肩胛骨的支架作用.1例肩胛骨转移性腺癌患者术中切断进入肿瘤的部分腋神经,切除肿瘤后适当游离远、近端直接吻合.结果 手术时间60～180min,平均120min;手术失血量300～100ml,平均460ml.所有患者无严重的术中及术后并发症.随访3个月～10年,平均4.2年.3例肩胛骨Ewing肉瘤患者术后8～24个月出现肺、脑和全身多发性转移而死亡.3例恶性纤维组织细胞瘤患者分别于术后10～22个月因肺转移及全身多发转移而死亡;1例术后6个月复发,带瘤生存.5例肩胛骨转移瘤患者分别于术后6～14个月出现非肩胛骨转移而死亡.其余5例原发恶性骨肿瘤患者随访期间未出现复发或转移.3例患者术后肩关节外展功能受限,前伸、后屈无受限.结论 微波原位灭活手术具有操作简便、疗效可靠、易于推广等优点,是一种理想的治疗肩胛骨恶性肿瘤的手术方法 .     

Fractures of the scapula

The scapula connects the arm with the chest wall and is therefore of great importance for a free range of shoulder of motion. For a long-term scapular fractures had been treated predominantly conservative. However, clinical studies of the past decades revealed that some fracture patterns deserve operative treatment to prevent unfavorable functional outcome and chronic state of pain. Scapular fractures are predominantly acquired during high-energy trauma and these patients' presents with a mean of 3.9 associated injuries in the emergency department. Injuries to the head, chest and ipsilateral upper extremity are most common. As some of these injuries are possibly life threatening they are treated first. Scapular fractures are only very seldom surgical emergencies. Therefore they are treated during the phase of reconvalescence in polytraumatized patients. Decision-making should be based on a thoroughgoing diagnostics, including conventional x-rays and a CT-scan, epically in cases of glenoid neck or cavity fractures. All fracture patterns should be identified to there full extend and put into the context of the scapular suspensory complex. The OTA lately presented a new and comprehensive system for classification of the scapular fractures. It is divided in two levels. Level one for the general orthopedic or trauma surgeon and Level two for the advanced upper Extremity or Shoulder surgeon. This classification scheme allows an easy access to understanding of the severity and prognostics of scapular fractures. As a general guideline surgery is indicated if a double disruption of the Scapula suspensory system, a relevant malposition or dysintegrity of the glenoid (articular surface) or a displacement of the lateral column is present.     

Three-dimensional motion of the scapula and shoulder during activities of daily living

The purpose of this study was to describe 3-dimensional scapular motion during the activities of daily living (ADL) and the full range of arm motion, and to suggest a standardized method for evaluating scapular mobility. Eight healthy subjects between the ages of 25-40, with no prior history of shoulder pathology or surgery for the past 12 months, were recruited for this study. Touching 8 predetermined landmarks on the head and the trunk was used to simulate ADL. Touching the contralateral ear and contralateral shoulder resulted in the maximum scapular protraction 46 degrees (8 degrees) and 48 degrees (8 degrees), respectively, and the maximum degrees of the scapular anterior tilt, -11 degrees (4 degrees) and -11 degrees (5 degrees), respectively. Asking patients to reach to the back of the neck, and the contralateral shoulder, the clinician can evaluate the overall scapular mobility in all directions. A protocol controlling the performance variability during ADL tasks was suggested to improve the clinical evaluation of the shoulder joint complex. Findings of this study can guide clinicians to identify specific tasks which may relate to particular shoulder girdle dysfunction.     

Free vascularized osteocutaneous flap from scapula to the tibia

Summary Microvascular transfer of a free vascularized osteocutaneous flap from the scapula to the tibia is presented. The patient had a 10 cm tibial bone defect and also required overlying soft tissue reconstruction. A scapular osteocutaneous flap was successfully transferred to the proximal tibial defect. No complications were seen during an 18 month follow-up. Although the contralateral fibula is a popular choice for tibial reconstruction, if it is not available, the free vascularized scapular osteocutaneous flap may be an alternative choice of treatment.     

Fractures of the scapula

One hundred thirty-seven fractures of the scapula in 121 patients were reviewed. The average age at the time of injury was 35 years, with fractures predominant in males (64%). The majority of cases (43%) involved fractures of the body of the scapula, with fractures of the scapular neck being second most common (26%). Automobile accidents produced the most injuries (52%), followed by auto-pedestrian (18%), falls (12%), and motorcycle accidents (11%). Associated bony or major soft-tissue trauma was present in all but 15 of the 121 patients, the most common being fractured ribs in 44%. Other associated injuries included fractures of the clavicle (26%), fractured skull (24%), cerebral contusion (20%), neurologic deficit (13%), and pulmonary contusion or hemo-pneumothorax (16%). Patients with injuries involving the acromion process or acromioclavicular joint had a significantly higher incidence of associated peripheral nerve injuries than those with other fractures of the scapula, indicating that special attention should be given to the neurologic examination of patients with these fractures. Careful neurovascular examination is mandatory. Treatment was usually conservative, independent of the location of the fracture, with satisfactory long-term results. We recommend simple immobilization followed by early active range of motion exercise.     

Duplication of the scapula

Summary Complete duplication of the scapula has not been described. We report two children both of whom had duplication of their right scapula associated with other malformations. In each case an operation was done to fuse the two abnormal scapulae together and the results were good.

---

Résumé La duplication complète de l'omoplate n'a encore jamais été publiée. Nous rapportons ici le cas de deux enfants qui présentaient tous deux une duplication de l'omoplate droite associée à d'autres malformations. Ils ont été opérés afin d'obtenir la fusion des deux os et les résultats ont été bons.