Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference?

Abstract

BackgroundSurgical treatment of scapular fractures with posterior approach is frequently associated with postoperative infraspinatus hypotrophy and weakness. The aim of this retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with the classic Judet versus modified Judet approach for scapular fracture.Patients and methods20 cases with scapular neck and body fracture treated with posterior approach for lateral border plate fixation were reviewed. In 11 of 20 cases, we used the modified Judet approach (MJ group), and in 9 cases we used the classic Judet approach (CJ group). All fractures were classified according to the AO classification system. At follow-up examinations, patients had X-ray assessment with acromiohumeral distance (AHD) measurement, clinical evaluation, active range of motion (ROM) examination, Constant Shoulder Score, and Disability of the Arm, Shoulder and Hand (DASH) Score. Infraspinatus strength assessment was measured using a dynamometer during infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT).ResultsDemographic data did not significantly differ between the CJ group and MJ group, except for mean follow-up, which was 4.15 years in the CJ group and 2.33 in the MJ group (p < 0.001). All X-ray examinations showed fracture healing. AHD was significantly decreased in the CJ group (p = 0.006). We did not find significant differences in active ROM between the MJ and CJ groups in the injured arm (p < 0.05). The Constant Score was 75.83 (±14.03) in the CJ group and 82.75 (±10.72) in the MJ group (p = 0.31); DASH Score was 10.16 in the CJ group and 6.25 in the MJ group (p = 0.49). IST showed mean strength of 8.38 kg (±1.75) in the MJ group and 4.61 kg (±1.98) in the CJ group (p = 0.002), ISRT test was 8.7 (±1.64) in the MJ group and 4.95 (±2.1) in the CJ group (p = 0.002). Infraspinatus hypotrophy was detected during inspection in six patients (five in the CJ group and one in the MJ group); it was related to infraspinatus strength weakness in IST and ISRT (p < 0.001).ConclusionsInfraspinatus-sparing surgical approach for scapular fracture avoids infraspinatus hypotrophy and external-rotation strength weakness. We suggest use of the modified Judet approach for scapular fracture and to restrict the classic Judet approach to only when the surgeon believes that the fracture is not easily reducible with a narrower exposure.Level of evidenceLevel IV.

Concomitant Intra-Articular Glenohumeral Lesions in Fractures of the Scapula Body

“…First of all, the number of included patients. Incidence of scapula body fractures is rather low, thus since the scapular body Fx is considered rare, the number of 21 enrolled patients can be regarded as adequate and similar compared to previous published studies focusing on scapula body Fx [15,34,36,37].…”

Surgical treatment of scapular malunion combined with chest deformity after trauma: a case report

“…Most scapular fractures can be adequately managed through less aggressive, limited approaches. 11,20,22,23 However, because of the need for a scapular osteotomy, removal of a newly formed bone, and rib fixation, we performed an extensive Judet approach, as suggested for surgery in delayed cases. 7,8 Dual plating of both medial and lateral scapular borders was performed.…”

Open Reduction and Internal Fixation of Extraarticular Scapular Neck and Body Fractures With Good Short Term Functional Outcome

“…A DASH score between 0 and 29 is considered to be the point where the patient no longer considers their upper limb disorder is a problem (20). Past studies reported mean DASH score between 8.1 and 14 for all patients who underwent surgical interventions for scapular neck and body fractures (10,13,16,18,19,21). The patient-reported functional outcome using SF-36 questionnaire scored between 70 and 89.6 (comparable to normal healthy population 61 to 84), with exception to two subcategories, i.e., REE (role limitations due to emotional problems) and REP (role limitations due to physical health).…”

“…We believe it is essential to restore the anatomy of the scapular blade to prevent scapulothoracic joint disorder such as snapping scapular syndrome resulting from the abnormal articulation of the scapulothoracic joint (15). The Modified Judet approach allows similar access to essential landmarks for fracture reduction and fixation with lesser soft tissue stripping, particularly the infraspinatus muscle and its blood supply (9,16). A drain was left under the infraspinatus muscle before closing the skin.…”