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骨科小将

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【骨折分类】肩胛骨骨折分类  

2017-02-03 11:38:57|  分类: 骨科分类 |  标签: |举报 |字号 订阅

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【肩胛骨骨折概述】
1.骨折发生率依次为:肩胛骨体部,肩胛颈,肩胛盂,肩峰,肩胛冈和喙突骨折;
2.65%肩胛骨骨折为混合型,涉及多个解剖部位;
3.其与胸腔比邻,11-54%发生肺挫伤,严重者需气管插管;
4.11-55%肩胛骨骨折合并气胸,气胸可在受伤时发生,也可几天后发生。尤其是张力性气胸,如患者突然出现喘憋症状,应警惕气胸发生;
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Scapula 14.1 A1 Extraarticular glenoid neck, simple

General considerations:

These fractures do not require surgery unless significantly displaced. The degree of displacement is judged by measuring the angle between the plane of the glenoid and the lateral scapular border. If the angle of displacement is greater than 20° than the normal anatomical angle, then surgery is indicated. If the displacement is left untreated, significant loss of shoulder motion will ensue.

Nonoperative treatment:

<20° deviation in angle between the glenoid and lateral scapular rim compared to the anatomical angle.

Supporting indications

  • Risk of surgery outweigh benefits

Advantages

  • No operative risks
  • No anaesthetic risk

Disadvantages

  • Delay in regaining full range of motion.
  • Increased risk of stiff shoulder

Contraindications

  • Neurovascular lesions
  • Associated fracture of humeral head which will be treated operatively
    【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Plate fixation
Main indication:
>20° deviation in angle between the glenoid and lateral scapular rim compared to the anatomical angle.

Supporting indications

  • Need for more stability and/or earlier mobilization

Advantages

  • Reduced risk of displacement
  • Earlier mobilization possible

Disadvantages

  • Possible need for hardware removal
  • Risk of nerve injury to the axillary and suprascapular nerve.

Contraindications

  • Patient unfit for surgery
  • Severe osteoarthritis
    【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将
     Scapula 14.1 A2 Extraarticular glenoid neck, wedge,同前

Scapula 14.1 A3 Extraarticular glenoid neck, multifragmentary

General considerations:

These fractures are usually unstable and require open reduction and fixation.余同前

【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将
 

Scapula 14.1 B1.1 Partial articular, anterior simple

General considerations:

Fractures of the articular rim render the joint unstable. This fracture is usually seen in patients with anterior shoulder dislocations and is therefore often associated with injuries of the glenoid anterior rim, the labrum, the ventral capsula and the rotator cuff.

Nonoperative treatment

Main indication:Low demand patients

Supporting indications

  • Additional osteoarthritis 
  • Full thickness rotator cuff tear

Advantages

  • No operative risks
  • No anaesthetic  risk

Disadvantages

  • Delay in regaining full range of motion.
  • Increased risk of shoulder instability
  • Increased risk of stiff shoulder and arthrosis
    【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将 
Lag screw fixation

Main indication

Large enough fragments to accommodate lag screw fixation.

Supporting indications

  • Need for more stability and/or earlier mobilization

Advantages

  • Reduced risk of displacement
  • Earlier mobilization possible
  • Additional shoulder injury can be addressed

Disadvantages

  • Possible need for hardware removal
  • Suture anchors Risk of nerve injury to the axillary and suprascapular nerve.
  • Risk of screw head interfering with the humeral head
  • Increased approach morbidity

Contraindications

  • Patient unfit for surgery
  • Severe osteoarthritis
    【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将
Suture anchors
Main indication:
Fragments too small to accommodate lag screw fixation.

Supporting indications

  • Need for more stability and/or earlier mobilization

Advantages

  • Reduced risk of displacement
  • Earlier mobilization possible
  • Additional shoulder injury can be addressed
  • Less approach morbidity

Disadvantages

  • Suture may cause foreign material granuloma

Contraindications

  • Patient unfit for surgery
  • Severe osteoarthritis
    【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Scapula 14.1 B1.2 Partial articular, anterior multifragmentary

Supporting indications

  • Additional osteoarthritis
  • Chronic rotator cuff tears
Large enough fragments to accommodate lag screw fixation.
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Suture anchors:Fragments too small to accommodate lag screw fixation.
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Scapula 14.1 B2.1 (2.2)Partial articular, posterior simple(multifragmentary)

 
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将 
 同前

Scapula 14.1 B3.1 Partial articular, transverse simple

General considerations:

These fractures may be undisplaced, minimally displaced or significantly displaced. The degree of displacement will dictate the treatment.

Lag screw fixation:Large enough fragments to accommodate lag screw fixation.

Scapula 14.1 B3.2 Partial articular, transverse multifragmentary

General considerations:These are high velocity injuries, most often displaced.

Lag screw fixation:Large enough fragments to accommodate lag screw fixation.

【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Scapula 14.1 C1 Complete articular, articular simple, neck simple

These fractures are mainly treated operatively.
Nonoperative treatment:Congruent articular surface; <20° deviation in angle between the glenoid and lateral scapular rim compared to the anatomical angle.

Supporting indications

  • Risk of surgery outweigh benefits

Advantages

  • No operative risks
  • No anaesthetic  risk

Disadvantages

  • Delay in regaining full range of motion.
  • Increased risk of stiff shoulder and arthrosis
  • Increased frequency of X-ray follow up

Contraindications

  • Step-off in the articular surface
  • Neurovascular lesions
  • Associated fracture of humeral head which will be treated operatively
Plate fixation
Main indication:
Non congruent articular surface;
>20° deviation in angle between the glenoid and lateral scapular rim compared to the anatomical angle.
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Scapula 14.1 C2 Complete articular, articular simple, neck complex/wedge

 These fractures are mainly treated operatively.
Main indication:
Congruent articular surface; <20° deviation in angle between the glenoid and lateral scapular rim compared to the anatomical angle.

Supporting indications

  • Risk of surgery outweigh benefits

Advantages

  • No operative risks
  • No anaesthetic  risk

Disadvantages

  • Delay in regaining full range of motion.
  • Increased risk of stiff shoulder and arthrosis
  • Increased frequency of X-ray follow up

Contraindications

  • Step-off in the articular surface
  • Neurovascular lesions
  • Associated fracture of humeral head which will be treated operatively
    【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将
Scapula 14.1 C3 Complete articular, articular multifragmentary

These fractures are mainly treated operatively.
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将

Scapula 14.2 Body and processes, acromion

General considerations:

Due to the displacement forces of the arm, the fractures of the acromion are most often displaced and most often treated operatively.

Nonoperative treatment

Non displaced fractures and no additional lesions to the shoulder girdle;

Advantages

  • No operative risks
  • No anaesthetic  risk

Disadvantages

  • Possible need for hardware removal
  • Increased frequency of X-ray follow up

Contraindication

  • Additional lesion of the LSSS or other fractures of the shoulder girdle

Lag screw fixation/Tension band

Main indication:Displaced fractures

Supporting indications

  • Presence of associated injuries to the shoulder girdle
  • Need for more stability and/or earlier mobilization

Advantages

  • Reduced risk of displacement
  • Earlier mobilization possible
  • In case of minor comminution, screws will offer better stability than tension band alone

Disadvantages

  • Possible need for hardware removal

Contraindications

  • Patient unfit for surgery
  • Severe osteoarthritis
    【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将
     
Scapula 14.3 coracoid processes
Main indication:Displaced fractures and associated injuries to the shoulder girdle.
【骨折分类】肩胛骨骨折 - 骨科小将 - 骨科小将
 

Scapula 14.4 Body

General considerations:

Absolute indication for operative treatment of the body of the scapula are open fractures. If a fracture pattern is such that it is directed towards the ribcage and causes irritation of the scapular thoracic articulation, such a fragment may have to be excised. Generally most other fractures are treated closed.

Nonoperative treatment:

Main indication:Provide mechanical support to begin shoulder movement

Advantages

  • No operative risks
  • No anaesthetic  risk

Disadvantage

  • Risk of non-union with associated pain

Contraindication

  • Near to penetration of the skin
  • Lesion of neurovascular structures
  • Extension of the fracture into the articular segment (In this case, the fracture should be addressed as and articular fracture)
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