Delayed union of a scapular fracture-an unusual cause of persistent shoulder pain

INTRODUCTION: Scapular fractures in athletes are rare, although they have been reported in football and baseball players. Most scapular fractures heal with nonoperative management; delayed union is rarely a problem. CASE SUMMARY: A 15-yr-old male fell onto his posterior shoulder after he had been pushed into the boards and then fell to the ice during a hockey check. He was diagnosed with a rotator cuff injury at an outside facility. Initial radiographs were negative. The patient was not immobilized, and he continued to play hockey despite intermittent pain. Seven months later, he presented to our sports medicine clinic, complaining of an aching pain at the base of his left shoulder. Examination revealed point tenderness along the base of the scapula, restriction of shoulder abduction, rhomboid weakness, scapular winging, and anterior impingement-type shoulder pain. A new radiograph, obtained at our sports medicine clinic, was nondiagnostic. Magnetic resonance imaging revealed increased signal on T2, with bone edema at the lateral margin of the scapular neck. A computed tomography scan revealed an unhealed, left-transverse, subglenoid scapular fracture. The fracture was nondisplaced. The patient was treated with transcutaneous electrical stimulation for 6 months and a physical therapy regimen focusing on periscapular strengthening. A final computed tomography scan, 6 months after initial presentation to our clinic, revealed healing of the fracture. Examination was normal. The patient was asymptomatic and was able to fully return to sports without any complications. CONCLUSIONS: Although scapular fractures in athletes are rare, they may occur, particularly in "contact sports" that share the energies of injury seen in high-speed motor vehicle collisions. Early identification and proper management are integral to decrease symptoms and to avoid protracted disability, particularly in athletes.     

重建钢板内固定治疗不稳定性肩胛骨骨折

目的 探讨应用重建钢板治疗伴有移位的不稳定性肩胛骨骨折的手术方法 和疗效.方法 对2005-08至2009-08收治的移位不稳定性肩胛骨骨折病例17例进行资料收集及随访,所有患者入院后均进行三维CT重建确定骨折类型及移位程度,并行重建钢板内固定治疗,术后早期功能锻炼.结果 获得完整随访16例,随访时间12～20个月,平均(15.45±1.27)个月,骨折完全愈合,按照Rowe肩关节功能标准评定,优良率达87.5%.结论 重建钢板内固定治疗有移位的不稳定性肩胛骨骨折可以获得较满意复位,早期进行肩关节功能锻炼以改善功能,减少骨折并发症的发生,是治疗肩胛骨骨折的一种积极有效的方法.     

肩胛骨骨折合并锁骨骨折治疗方法探讨

目的探讨肩胛骨骨折合并锁骨骨折的治疗方法. 方法 23例肩胛骨骨折合并锁骨骨折的患者,13例行保守治疗,2个月后进行肩关节功能锻炼;10例行锁骨骨折、肩胛骨骨折切开复位重建钢板内固定,术后4周进行肩关节功能锻炼. 结果 23例患者骨折全部愈合.18例获随访,其中手术治疗8例,保守治疗10例,随访时间8～16个月,平均12个月.手术患者7例肩关节功能恢复优良,1例可;保守治疗患者6例肩关节功能恢复优良,3例可,1例差. 结论肩胛骨骨折合并锁骨骨折切开复位内固定,恢复了肩关节的动力平衡及稳定性,可早期进行功能锻炼,是一种较好的治疗方法.     

Scapular Fracture in a High School Football Player

Scapular fractures are rare in brief athletes, but they have been reported in professional football players who play high-collision positions. This case report of a painful, nondisplaced scapular fracture in a 17-year-old high school offensive and defensive lineman shows that these fractures can happen even in amateur athletes. A scapular fracture may mimic a rotator cuff injury, as happened initially in this case. Conservative treatment is usually appropriate for these fractures unless there is severe displacement.     

双边外固定架牵张固定治疗难治性pilon骨折

目的总结分析双边外固定架牵张治疗难治性pilon骨折的疗效。方法治疗Redi-AllgwerⅢ型pilon骨折13例,其中闭合骨折9例,开放骨折4例,采用双边外固定架牵张治疗。结果 1例创面感染,2例出现针道红肿,1例开放骨折4月后仍无明显骨痂形成,手术植骨后骨质愈合。踝关节功能:优3例,良8例,可1例,差1例。1例患者出现明显创伤性关节炎,于1年后行踝关节融合术。结论应用双边外固定架结合有限内固定牵张治疗难治性pilon骨折是一种有效的治疗方法。     

Evaluation of occult cervical spine fractures on radiographs and CT

The aim of this study was to evaluate occult cervical spine fractures on radiographs and CT. We reviewed radiographs of 68 patients with cervical spine fractures at a level 1 trauma center. Twenty-six patients showed occult fractures on initial radiographs. Of seven odontoid fractures, two were diagnosed only after thinner repeat CT reconstructions. Five facet fractures were best seen on CT reconstructions. Three occult hangman's fractures were seen by CT. A C1 fracture was diagnosed on CT only. Two fractures through the C2 body were seen only by CT. Eight fractures were obscured by patient's shoulders, including five clay shoveler's fractures, a C6 facet fracture, a bilateral C6 pedicle fracture, and a C7–T1 fracture–dislocation. Odontoid, facet, and lower cervical spine fractures are most commonly occult on radiographs. CT, especially high-quality CT reconstructions for odontoid and facet fractures, can improve the diagnosis of cervical spine fracture. No support was provided for this study. The study was performed in the Department of Radiology, University Hospital at Stony Brook, Stony Brook, NY, USA     

肩胛颈骨折的分类和手术治疗

目的 探讨肩胛颈骨折的分类及手术治疗. 方法对2000年1月-2007年12月收治的18例肩胛颈骨折进行回顾分析.男12例,女6例;年龄17～62岁,平均41岁.全部行CT检查.根据Hardegger分型,解剖颈骨折10例,外科颈骨折8例;按照Miller分型,ⅡA5例,ⅡB6例,ⅡC6例,ⅡB+ⅡC1例.15例有合并损伤.手术入路为后外侧入路9例,改良Judet入路6例,前后联合入路3例,应用重建钢板和拉力螺钉固定骨折. 结果全部患者随访6～70个月,平均25.5个月.根据Constant-Murley评分评价疗效,平均73分(35～95,中位数75.5).并发复位不良2例,肩关节不稳定1例,创伤性关节炎3例. 结论肩胛颈骨折成角畸形孟极角<20°、骨折移位≥10 mm、合并浮肩损伤或肩关节上方悬吊复合体损伤时,应早期手术治疗.预后影响因素主要为合并损伤、复位质量、固定坚强程度、肩袖损伤及术后康复等.     

Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature

Avulsion fractures of the tibial tubercle are uncommon. Bilateral tibial tubercle avulsion fractures are extremely rare. In this article, we describe Watson-Jones type III simultaneous bilateral tibial tubercle avulsion fractures in a 17-year-old boy who fell on the ground while taking off in high jump in sport. An open anatomic reduction and internal fixation was performed. We report here on the successful surgical treatment of a simultaneous bilateral fracture of the tibial tuberosity in an adolescent. These types of fractures involve a growth plate, extend through the articular surface and appear to do well with open reduction and secure internal fixation despite their bilateral nature, with recovery and functional outcome comparable to results from unilateral tibial tubercle avulsion fractures.     

Anterior oblique projection in radiography of the traumatized shoulder

A series of 132 consecutive shoulder radiographs of traumatized patients was analyzed prospectively. Each shoulder examination included anteroposterior projections with external and internal rotation of the humerus and an anterior oblique projection. Each view was evaluated for the abnormalities that were identifiable on it. There were 84 normal examinations and 48 abnormal examinations. There were 29 fractures, dislocations, or acromioclavicular separations identified. Two fractures of the greater tuberosity were seen only on the anteroposterior projection with external rotation. One humeral head fracture and three scapular fractures were visualized only on the anterior oblique projection.     

锁定加压接骨板治疗肱骨近端骨折

目的 总结肱骨近端锁定加压接骨板(locking proximal humerus plate,LPHP)治疗肱骨近端骨折的临床疗效.方法 肱骨近端骨折45例,根据Neer分型:三部分骨折33例,四部分骨折12例.经胸大肌、三角肌入路,采用LPHP固定.用Neer肩关节功能评分标准行术后患肩功能评分.对两组疗效行统计学比较.结果 38例获得平均14.7个月随访.3个月内骨折愈合35例,4个月愈合3例.按Neer肩关节功能评分标准:优20例,满意15例,优良率达92%.结论 LPHP治疗肱骨近端骨折具有固定牢靠、并发症少、满意率高等优点,是一种较好的固定肱骨近端骨折的内置物.     

浮肩损伤的临床特征和治疗

目的 总结浮肩损伤（floating shoulder injury，FSI）的临床特征和治疗效果。方法1993年1月-2004年9月收治浮肩损伤患者8例，除2例行锁骨固定带固定外，其余6例均行手术治疗，其中单纯行锁骨切开复位重建钢板内固定1例，同时行肩胛骨内固定5例。受伤至手术时间为2h～7d，平均3．5d，术后6个月对患肩功能进行Constant评分判定疗效，并对浮肩损伤的临床特征和治疗进行总结。结果6例患者经过6个月～3年（平均11个月）的随访，锁骨和肩胛骨骨折均愈合，肩关节活动范围无明显受限，但有2例患者在举重物时肩关节有轻度的疼痛，1例患侧上肢肌力较对侧稍减弱。术后6个月患肩功能Constant评分平均为93分。结论浮肩损伤多为高能量暴力所致的不稳定性肩胛带损伤，在治疗方案上尚存争议。但对移位明显的浮肩损伤以及有伴发伤的浮肩损伤进行手术治疗是必要的。     

Case report: bilateral ischial stress fractures in an elite tennis player

A case report of bilateral ischial stress fractures in an elite tennis player initially mimicking hamstring pathology is described. This is an unusual site of stress fracture. Typical sites of stress fracture are well documented; however, awareness of less common sites of stress-related bone injury can aid early diagnosis and treatment before overt fracture occurs.     

The prevalence and significance of missed scapular fractures in blunt chest trauma

Recent concepts regarding surgical management of fractures of the glenoid and scapular neck provide a new imperative to their early recognition. The initial routine supine chest radiograph obtained in patients with major blunt chest trauma provides the earliest opportunity to identify scapular fractures. A retrospective analysis of 100 patients with major blunt chest trauma who were discharged with the diagnosis of scapular fracture was performed to determine (1) the frequency with which the diagnosis of scapular fracture was made on the initial chest radiograph and (2) the prevalence and type of regional injuries that could serve to identify which of these patients are most likely to have sustained scapular fracture(s). The scapular fracture was diagnosed on the initial chest radiograph in only 57 (57%) of 100 patients and, although present, was not recognized in 43 (43%) of 100. In the group in which the fractures were not recognized, the fracture was visible and frankly overlooked in 31 (72%) of 43. The fracture was not included on the examination in eight (19%) of 43; and it was obscured by superimposed structures or artifacts in four (9%) of 43. Ipsilateral regional injuries were present in 88 (88%) of 100. These included multiple upper rib fractures in 40 (40%), clavicular fractures in 17 (17%), acromioclavicular separation in six (6%), and "other" in 26 (26%). "Other" included subcutaneous emphysema, pneumothorax, pleural effusion, and pulmonary contusion. The presence of ipsilateral regional skeletal injuries and soft-tissue injuries after major blunt chest trauma should prompt a diligent search for concomitant scapular fractures.     

肩胛骨外侧缘直切口手术治疗肩胛骨颈下和体部骨折

目的探讨肩胛骨颈、体部骨折的新型入路手术治疗方法及临床效果。方法2002年12月-2004年10月收治肩胛骨颈、体部骨折共13例，男9例，女4例；年龄22～48岁，平均31岁。其中颈部骨折7例，有2例合并锁骨骨折；单纯体部骨折6例。合并肱骨头半脱位7例，合并肋骨骨折3例。全部患者均采用肩胛骨外侧缘直切口切开复位重建钛钢板、螺钉行内固定术。结果术中出血30～80ml，手术时间40～80min。术后随访4～24个月，骨折平均愈合时间6～8周，10例患者随访功能满意。结论肩胛骨颈下、体部骨折通过沿肩胛外侧缘做一直切口的新型入路手术治疗方法能够以较小的创伤完成肩胛骨颈下、体部骨折的满意复位及内固定，同时获得满意的功能恢复。     

Symptomatic pathological fracture of odontoid as the primary presentation of multiple myeloma: Evaluation by 3D CT,conventional MR imaging,and in-phase and opposed-phase MR technique

Odontoid fractures commonly occur as a result of traumatic cervical spine injuries; pathological fractures being distinctly uncommon. Malignant tumors involving atlanto-axial spine are uncommon, metastases remain a common cause of pathological fractures at this site. Although, myeloma deposits in the cervical spine often occur, primary presentation of multiple myeloma with pathological fracture of odontoid consequent to such deposits is extremely rare. The above feature and its occurrence at an unusual site are the highlights of this report. A short review of the available literature has also been done. We further describe the utility of in-phase and opposed-phase imaging in differentiation of benign from malignant vertebral fracture in context to the present case.     

A single fracture in the ring of vertebrae below the atlas: report of four cases

A single fracture of the ring of a vertebra is a rare injury of the spine. In this report, we present five single fractures of the posterior ring of the cervical spine below the atlas from four patients after motor vehicle accidents. Initial radiographs failed to show any of these fractures; all were detected by computed tomography. Single ring fractures are stable and none of our patients presented with a neurological deficit. Patients were treated conservatively with a cervical collar or a cervicothoracic brace. They all recovered without any neurological abnormalities.     

Evaluation and management of scapular dysfunction

The scapula plays an important role in shoulder function and requires both significant mobility and stability. Normal motion is 3-dimensional, and during arm elevation consists of upward rotation, posterior tilting, and external rotation as well as clavicular elevation and retraction. Examination should include visual observation, symptom alterations tests, testing of muscle strength, and flexibility of key structures including the pectoralis minor, posterior shoulder and thoracic spine. Treatment consists of graded resistive exercise, neuromuscular retraining, stretching, manual therapy, and taping where necessary. Although several studies suggest a relationship between abnormal scapular motion and symptoms, strong evidence directly supporting a causal relationship is lacking and further work is necessary to clarify this relationship.     

Sequential avulsion of the anterior inferior iliac spine in an adolescent long jumper

We present here an unusual case of a sequential avulsion fracture of the anterior inferior iliac spine (AIIS), occurring first in the right and then the left AIIS, during long jump attempts. The case of a 17 year old boy with pain around his right groin, which first occurred during a long jump attempt, is presented. Radiographic examination revealed an avulsion fracture of the right AIIS. After conservative treatment, full athletic activity was allowed 2 months after the injury. However, 4 months later the patient returned with a similar pain in the opposite side of his groin. Radiographs revealed another fracture of the left AIIS. The boy underwent the same treatment protocol; he was examined with isokinetic dynamometry. No complication or re-injury occurred during the 2 year follow up period. In the present study, we introduce the first case of a sequential bilateral AIIS avulsion fracture caused by a long jump.     

19-year-old male adolescent with bilateral femoral neck stress fractures: a case report

The medical literature describes very few cases of bilateral femoral neck stress fractures in healthy adolescents. We studied the case of a healthy adolescent male Marine who suffered severe bilateral femoral neck stress fractures within a span of 7 months. As his level of exercise was no different than his other colleagues, his case was closely scrutinized using biochemical studies, bone specimens, and activity modification over the course of several months. Laboratory studies and observation yielded unremarkable findings, and he went on to return to full training regimens for combat deployments. Thus, even in young healthy males, this type of injury can occur without bony pathology; furthermore, an aggressive surgical approach can result in an optimal outcome.     

Case report 319

Three cases of bilateral pelvic avulsion fractures in adolescent sprinters are reviewed. Anacute avulsion fracture of the anterior superior iliac spine (ASIS) occurred during active running in three teenaged sprinters. Radiography confirmed a healed fracture of the contralateral ASIS. The clinical features and radiologic appearances are characteristic. The pathophysiology of this type of unique pediatric fracture is discussed. Conservative treatment is successful.