The treatment of double disruption of the superior shoulder suspensory complex

Oh, Chang Wug; Kyung, Hee-Soo; Park, Bung Chul; Kim, Poong Taek; Ihn, Joo Chul

doi:10.1007/s00264-001-0325-1

Cited by 60 publications

(39 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Scapular fractures are uncommon, high-energy injuries usually with associated injuries [1,6,13,20,[25][26][27][28][29]. Because the scapula is enveloped by thick muscle, fractures heal quickly and predictably [18].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures

Jones

Sietsema

2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Operative indications for displaced scapular fractures have been controversial and inconsistent. Surgeons have been dissuaded to operate on these uncommon fractures because of the complex anatomy, approaches, and fracture patterns. It is unclear whether return to work, pain, or complications differ in patients with scapular fractures treated nonoperatively or operatively. Questions/Purposes We therefore assessed differences in rates of union, range of motion, ability to return to work, pain, and complications between operatively and nonoperatively treated scapular body and neck fractures. were treated with open reduction internal fixation and matched by age, occupation, and gender to 31 patients treated nonoperatively. The proportions of AO/OTA fracture types were similar in the two groups. The mean displacement, shortening, and angulation were greater in the operative group as compared with the nonoperative group. All patients were followed until healing or discharge from care (average, 1.5 years; range, 14-32 months). We assessed complications, return to work, and radiographic healing. Results All fractures healed. We found no differences in return to work, pain, or complications. Conclusions Our observations suggest operative treatment of displaced scapula fractures results in similar healing, return to work, pain, and complications as nonoperative treatment. We do not recommend operating on any scapular neck or body fractures displaced less than 20 mm. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

show abstract

Section: Discussionmentioning

confidence: 99%

Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures

Jones

Sietsema

2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Furthermore, there were three postoperative hematomas with the need of revision surgery to evacuate (9,14), one heterotopic ossification (18), two implant failures (22), four malunions (22), and two superficial wound infections (14). The calculated overall rate for postoperative complications was 10.2%.…”

Section: Resultsmentioning

confidence: 99%

A Meta-Analysis of Operative Versus Nonoperative Treatment In 463 Scapular Neck Fractures

Dienstknecht¹,

Horst²,

Pishnamaz³

et al. 2013

Scand J Surg

View full text Add to dashboard Cite

Background and Aims: Treatment of scapular neck fractures remains controversial. Advantages of surgical treatments, such as anatomical restoration of fracture displacement, are counterbalanced by approach morbidity. We conducted a meta-analysis of 463 scapular neck fractures and compared clinical, functional, and radiographical outcomes in operatively and nonoperatively treated scapular neck fractures.Material and Methods: A literature search was conducted, including the databases PubMed/MEDLINE, Embase, and the Cochrane Database of Systematic Reviews. Manuscripts were included if they reported a precise description of treatment, complications, functional outcomes, and/or radiographic evaluation. Data about day-to-day activities, level of pain-freeness, range of motion, functional grading, and radiographical assessment were pooled and compared using fixed effects models.Results and Conclusions: A total of 22 manuscripts were relevant, including 1 prospective cohort study and 21 retrospective studies. The studies showed a high heterogeneity in the result assessment. Most patients had concomitant injuries. In total, 234 out of the 463 fractures were treated operatively. Pain-freeness and radiographic outcome measurements were significantly better in the operatively treated group, whereas range of motion was significantly improved in the nonoperative treated patients. Complication rate for surgical treatment was about 10%. From the achievable data, there was no bias detected when comparing the two treatment groups. However, those data could not be analyzed for all included studies. For the same reason, the role of additional surgical treatment for concomitant injuries to the shoulder girdle could not be cleared completely. Caution should be exercised, and individual injury patterns have to be taken into consideration when considering the best treatment options.

show abstract

“…The surgical approach to a double disruption of the SSSC in which an unacceptable displacement has occurred is reduction and stabilisation of at least one of the injury sites, creating a more stable anatomical situation. [4][5][6][7][8]11,12,[14][15][16] In a recent review of operative treatment of scapular fractures, in which approximately 25% had a concomitant injury to the clavicle or acromioclavicular ligaments, good-to-excellent functional results were obtained in about 85% of the cases. 10 In this case report, we stabilised two out of the three (acromion fracture and acromioclavicular joint disruption) injured SSSC components.…”

Section: Discussionmentioning

confidence: 95%

Open superior shoulder suspensory complex injury: A case report

Calafi

Yoo

2009

Injury Extra

View full text Add to dashboard Cite

The superior shoulder suspensory complex (SSSC) is a bony and soft tissue ring created by the glenoid, coracoid, coracoclavicular ligament, distal clavicle, acromioclavicular ligament and the acromion. 4 Biomechanically, this complex serves an important function by providing a stable link between the upper extremity and the axial skeleton. Each of its components has its own individual role and provides multiple points of attachment for a variety of musculotendinous and ligamentous structures. Single disruptions of this ring, such as an isolated clavicle fracture, are common and do not violate its structural integrity. Double disruptions, though infrequent, can destabilise the ring. The resulting deformity may lead to adverse healing and long-term functional consequences, such as weakness and discomfort, subacromial impingement and degenerative joint disease. 5,15 Even though non-operative treatment of floating shoulder injuries, especially those with minimal displacement, can achieve satisfactory results, 2 surgical correction of deformity can positively impact the functional outcome. 7,8,11,16 We report an unusual case of a patient who sustained a scapular neck fracture, an open acromion fracture and an acromioclavicular joint disruption. To our knowledge, this is the first report of an open segmental injury to the SSSC. Our patient was informed that data concerning the case would be submitted for publication. Case reportA 52-year-old, otherwise healthy, right-hand dominant man, who was involved in a motorcycle accident, presented with complaints of pain in the left shoulder. A detailed neurovascular examination revealed a normal left upper extremity and neck. However, a 12-cm stellate wound existed along the cephalad aspect of his superolateral shoulder. The acromion and distal clavicle were evident through the defect.A radiographic imaging revealed left-sided second and third rib fractures, along with a small left apical pneumothorax. The skeletal injuries included a displaced comminuted acromion fracture consisting of anterior and posterior segments, an acromioclavicular joint dislocation and a displaced scapular neck fracture (Fig. 1).Initial care in the emergency room consisted of local wound care, antibiotic and tetanus toxoid administration as well as placement of a left thoracostomy tube. Within 4 h of presentation, the patient underwent a formal irrigation and debridement (I&D) and surgical stabilisation of his orthopaedic injuries.Intra-operative assessment of the injury confirmed a displaced segmental acromion fracture with a concomitant acromioclavicular joint disruption. The anterior and middle heads of the deltoid muscle were avulsed from their acromial insertion sites. In addition, the supraspinatus tendon demonstrated a small partial-thickness tear near its insertion. After a thorough I&D, the supraspinatus tendon was repaired first using a 2/0 FiberWire suture. The wound was extended medially along the inferior border of the clavicle for approximately 3 cm to gain additional exposure. The SSSC w...

show abstract

The treatment of double disruption of the superior shoulder suspensory complex

Cited by 60 publications

References 12 publications

Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures

Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures

A Meta-Analysis of Operative Versus Nonoperative Treatment In 463 Scapular Neck Fractures

Open superior shoulder suspensory complex injury: A case report

Contact Info

Product

Resources

About