Bilateral scapular fractures secondary to electrical shock

Summary Fractures of the scapula are rare injuries. Usually the scapula requires a high-energy impact to sustain a fracture [l]. Various fractures have been noted as a result of convulsive seizures. We report bilateral scapular fractures caused by electric shock and discuss their pathomechanical origin.     

Management of scapular fractures

With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as allowed by the patient's pain. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. However, little agreement exists on indications for surgery, and there is no clear comparative evidence on outcomes for surgically versus nonsurgically managed fractures. Scapular fractures are the result of high-energy mechanisms of injury, and they often occur in conjunction with other traumatic injuries. In addition to performing meticulous physical and neurologic examination, the surgeon should obtain plain radiographs, including AP shoulder, axillary, and scapular Y views. Three-dimensional CT is used to determine accurate measurements in surgical candidates. Surgical approach, technique, and timing are individualized based on fracture type and other patient-related factors.     

肩胛骨骨折的手术治疗

肩胛骨骨折相对少见,多因高能量创伤致肩背部遭受直接暴力所致。常伴有合并伤,高达80%～95%,应注意检查臂丛神经、血管以及同侧肢体损伤。骨折治疗的目的是恢复肩关节无痛性有效的肩关节活动功能。移位性关节盂骨折﹑肩部悬吊复合体联合损伤﹑浮肩损伤以及移位性肩胛颈骨折均应行手术治疗,内固定必须牢固可靠,能耐受早期肩关节活动。康复训练是手术成功的重要因素,术后患者应坚持肩关节活动至骨折牢固愈合。     

肩胛骨骨折的治疗策略

目的探讨肩胛骨骨折的损伤特点与治疗策略。方法回顾性分析自2007—09--2012-09收治的138例肩胛骨骨折,包括24例采用非手术治疗,114例采用手术治疗。结果138例获平均16．2个月（12—24个月）的随访。术后X线片显示骨折全部愈合,愈合时间平均11．8周（10-14周）。末次随访时肩关节Constant-Mudey评分平均85．6分（54～100分）;术后疗效按Hardegger疗效评价标准判定：优87例,良32例,可15例,差4例,优良率86．2％。结论肩胛骨骨折患者应全面评估损伤情况,完善影像学检查,明确骨折类型和手术指征,选择最佳的治疗方案,争取肩关节功能最大程度的恢复。     

手术治疗肩胛骨骨折

<正>2005年1月~2012年12月,我科对20例肩胛骨骨折患者根据不同类型采用不同手术入路进行早期内固定治疗,取得良好效果,报道如下。1材料与方法1.1病例资料本组20例,男12例,女8例,年龄20~67岁。均为单侧肩胛骨骨折。骨折按解剖区域分型:肩胛盂骨折3例,肩胛颈骨折4例,肩胛体骨折6例,肩胛冈骨折4例,肩峰骨折2例,喙突骨折1例。合并伤:多发性肋骨骨     

肩胛骨骨折的手术治疗效果

目的探讨肩胛骨骨折手术治疗的效果。方法18例肩胛骨骨折患者均手术治疗,术后适当功能锻炼。结果患者均获随访,时间10～29个月。采用Neer标准评定肩关节功能：优良8例,满意7例,不满意3例。结论肩胛骨骨折手术治疗效果尚不确实,应严格选择手术病例,争取早期手术,并早期功能锻炼,可获得满意疗效。     

肩胛骨骨折的手术治疗

目的探讨切开复位内固定治疗肩胛骨骨折的适应证及疗效.方法对9例患者经肩后入路行切开复位,采用重建钢板、拉力螺钉或克氏针内固定, 术后早期功能锻炼.结果 9例随访12～40个月,疗效:优6例,良2例,可1例.结论在严格掌握手术指征的基础上对肩胛骨骨折行内固定治疗,利于早期功能锻炼,减少并发症,肩关节功能恢复较好.     

The significance of scapular fractures

Scapular fractures in the multiply injured patient have received little attention. Fifty-six patients with 58 scapular fractures secondary to blunt trauma were reviewed. The patients averaged 3.9 major injuries excluding their scapular fractures. The injury pattern associated with blunt scapular fracture is unique. Patients with scapular fracture have a high incidence of injury to the ipsilateral lung and chest wall and to the ipsilateral shoulder girdle and its contained structures: rib fractures, 53.6%; pulmonary contusions, 53.6%; clavicular fracture, 26.8%; brachial plexus injury, 12.5%; subclavian, brachial, or axillary artery injury, 10.7%. Eight patients died (14.3%). Although no patient died from the scapular fracture, half of the deaths in this series were the result of pulmonary sepsis arising in an associated ipsilateral pulmonary contusion. Scapular fractures provide the trauma surgeon with a reliable clinical clue that the patient is at inordinate risk to have associated injuries of major consequence to the ipsilateral lung and chest wall, the ipsilateral shoulder girdle, and the ipsilateral subclavian, axillary, or brachial artery.     

肩胛骨骨折的手术治疗

目的 :探讨手术治疗各型肩胛骨骨折的可行性及适应证 ,评价手术治疗的临床疗效。方法 :对手术治疗并获随访的 2 5例肩胛骨骨折进行回顾性分析。术前常规行肩胛骨的正位、侧位及前 30°斜位的X线摄片 ,用Jesser法将骨折进行分型 ,手术采用Judet入路进行骨折内固定。结果 :术后随访 8个月至 3年 5个月 ,平均 2 0个月 ,按Dolfi等评分系统进行功能评定 ,优 (13～ 16分 ) 10例 ,良 (9～ 12分 )11例 ,可 (5～ 8分 ) 3例 ,差 (小于 4分 ) 1例 ,优良率为 84 %。结论 :手术治疗肩胛骨骨折已成为安全、可靠的治疗手段 ,累及关节面并有移位的肩盂骨折、有移位的肩胛骨颈部骨折以及肩胛冈粉碎性骨折是手术治疗的绝对适应征。对预期功能要求比较高的病人 ,可适当放宽手术指证。熟练的手术技巧和可靠的内固定以及早期积极的功能锻炼是提高疗效的关键     

肩胛骨骨折的手术治疗

目的探讨肩胛骨骨折手术治疗的效果。方法对30例肩胛骨骨折患者根据不同类型分别采用不同手术入路进行内固定治疗。术后进行科学功能锻炼。结果患者均获随访,时间6～36个月。采用ASES评分标准评定肩关节功能:优20例,良7例,中等2例,差1例。结论肩胛骨骨折早期手术,术后科学功能锻炼,可获得满意疗效。     

手术治疗肩胛骨骨折

正2012年1月~2015年1月,我科手术治疗14例肩胛骨骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组14例,男11例,女3例,年龄19~55岁。左侧8例,右侧6例。肩峰喙突骨折1例,体部骨折12例,颈部骨折1例。受伤至手术时间7~14 d。1.2治疗方法全身麻醉下手术。患侧上肢消毒包扎放置于手术台上,以便     

肩胛骨骨折的手术治疗进展

肩胛骨骨折很少见,占所有骨折的0.5％?1.0％[1-2].高能外伤是导致此类骨折的常见受伤机制.据报道,肩胛骨骨折患者的死亡率在10％?15％,这是因为此类骨折经常伴有肺部、颈椎或颅脑等其他系统损害[3].由于肩胛骨被多块肌肉包裹,为骨折愈合提供了丰富的血管供应,因此大多数肩胛骨骨折保守治疗可获得满意效果[4-5]....     

Lower mortality in patients with scapular fractures

BACKGROUND: The purpose of this research was to compare associated injuries and mortality in multiply injured patients with scapular fractures with those without scapular fractures. METHODS: A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score >12 admitted to a level I regional trauma center during from January 1, 1996, to December 31, 2001, was reviewed to assess skeletal and organ injuries associated with a scapular fracture. RESULTS: Of 2,538 motor vehicle occupants, 94 occupants with concomitant scapular fractures and 2,444 occupants without scapular fractures revealed that 76.6% of motor vehicle occupants who sustained scapular fractures were males with a mean age of 44.3 years (SD=18.9). The presence of a scapular fracture reduced the risk of mortality by 44% (95%CI: 1-75%). Patients with scapular fractures had a greater proportion of flail chest injuries [relative risk (RR), 8.8; p < 0.001], clavicle fractures (RR, 4.5; p < 0.001), rib fractures (RR, 3.1; p < 0.01), spine fractures (RR, 2.7; p < 0.001), and tibia and fibular fractures (RR, 1.7; p < 0.025). The presence of a chest injury, either a pneumothorax (RR, 3.7; p < 0.001) or a pulmonary contusion (RR, 3.5; p < 0.001), was significantly more likely in patients with scapular fractures than control patients. Injuries to the spleen (RR, 2.4; p < 0.01) and liver (RR, 2.2; p < 0.025) were also significantly more common in patients with scapular fractures when compared with those without them. CONCLUSIONS: In an observational study of multiply injured trauma patients from motor vehicle crashes, we report the following: (1) scapular fractures occur 3.7% of the time; (2) the presence of a scapular fracture was associated with a lower mortality; and (3) scapular fractures should alert healthcare personnel to the presence of other injuries, such as chest injuries, clavicle fractures, rib fractures, spine fractures, tibial fractures, and spleen and liver injuries. Our findings should be interpreted cautiously, because the mechanism of the association between scapular fractures and mortality remains unclear.     

The operative treatment of scapular fractures

Fractures of the scapula occur mainly from direct trauma involving considerable violence and associated injuries of the shoulder and thorax are common. In most cases early functional treatment gives good or excellent results. Operative treatment may, however, be indicated, especially with displaced intra-articular fractures, fractures of the glenoid rim associated with humeral head subluxation, or unstable fractures of the scapular neck. Between 1967 and 1981, we treated 37 such fractures by open reduction and stable osteosynthesis. We were able to follow up 33 cases (89%), of which 21 (64%) had complete functional recovery. The other 12 had varying degrees of pain, loss of mobility, and weakness. Overall, however, 79% of the patients had good to excellent results.