Scapulothoracic fusion using nonabsorbable suture fixation: surgical technique and review of the literature

Abstract

Background: Historically, scapulothoracic fusion (STF) is performed using steel wire and plate construct fixation. The purpose of this study is to report a recent fusion achieved through ultra-high-molecularweight polyethylene-reinforced suture fixation as well as to perform a systematic literature review of techniques, fusion rates, complications, and reoperation. Methods: Patient data were gathered from chart review and clinical encounters. For the review, MED-LINE, Embase, and Ovid databases were queried for STF cases. Thirty articles reporting on 386 fusion procedures were included. Results: Including this patient, 5 of 387 (1.3%) STFs have been attempted with fiber suture. Fusion rates of metal-only constructs is 90.8% (346 of 381) with 11.3% (43 of 381) requiring wire removal or trimming because of symptomatic hardware and 7% (27 of 381) causing a postoperative pneumothorax. Although a small sample size, all fiber-suture constructs have achieved union without implant removal and without pneumothorax development. In this patient, fusion was determined radiographically at 6 months with substantial improvement in pain level and function. Conclusion: Scapulothoracic fusion has benefit to patients to have failed other management options for winged scapula, most commonly those with neurologic trauma or facioscapulohumeral muscular dystrophy. With advancements in surgical options, fiber-suture offers an alternative to steel wire to achieve fusion. Further cases with longer term follow-up are needed to determine if significant differences in outcomes exist between constructs.

In silico analysis of rib force distribution in postscapulothoracic arthrodesis model

“…The ribs are trimmed in the CAD software coronally and sagittally only to contain the portions that contact the scapula to decrease the simulation time (Figure 1A). Only ribs 2 through 7 are included in the initial model since only those ribs have been used for the STA procedure in the literature 10 …”

“…Only ribs 2 through 7 are included in the initial model since only those ribs have been used for the STA procedure in the literature. 10 2.2 | Computational simulations…”

Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes

“…Multifilament metal cables are reliable implants, but prominent crimps that are used to secure loops may cause skin irritation and may require removal. Recently, a high-strength suture fixation method has also been proposed ( 58 ). Currently, there is no study on the efficacy of this fixation method, and it is a matter of debate if they preserve the initial compression or not.…”