[A comparative study on operation and non-operation in treating fractures of scapular neck].

ABSTRACT

OBJECTIVE: To explore the effective method for treatment of fractures of scapular neck. METHODS: A retrospective analysis of 30 patients with fractures of scapular neck was done. The patients were treated by operation or by non-operation from May 1994 to May 2003. According to the degree of displacement, 30 cases included 9 mild displaced fractures(<10 mm) and 21 severe displaced fractures(>10 mm). According to the location of fractures, there were 24 cases of surgical neck fractures and 6 cases of anatomical neck fractures. Of all 30 patients, 12 were treated by non-operation and 18 by operation. All fractured scapular necks were exposed through posterior approach and fixed with interfragmentary compression screws, reconstruction plates and so on after satisfactory reduction. Associated clavicle fractures were exposed through Langer's approach and fixed with Kirschner wire-tension band fixation construct, reconstruction plates and so forth. When followed up, the clinical examination was done and the X-ray films were taken to measure glenopolar angle(GPA). Herscovici's score was adopted. RESULTS: Twenty-eight patients were followed up from 14 days to 9 years. Among 11 patients treated by non-operation, Herscovici score showed that 4 cases achieved the excellent result, 2 cases good, 2 cases fair and 3 cases poor and the X-ray film results showed that there were 6 cases of GPA>20 degrees and 5 cases of GPA<20 degrees. Of 17 patients treated by operation, Herscovici score showed that 11 cases achieved the excellent result, 5 cases good and 1 case fair and the X-ray film results showed that there 16 cases of GPA>20 degrees and 1 case of GPA<20 degrees . CONCLUSION: Fractures of scapular surgical neck with mild displacement can be treated by non-operation, while fractures of surgical neck with severe displacement or associated with ipsilateral clavicle fractures, and fractures of anatomical neck should be treated by operation to reconstruct the stability of shoulder and minimize the complications.