Classification of scapular body fractures.

INTRODUCTION: The aim of this study is to present, on the basis of 3D CT reconstructions of 187 of scapular body fractures, a clinically oriented classification respecting the biomechanical architecture of the scapula. METHODS: In a series of 375 scapula fractures we identified 187 body fractures in187 patients (157 men, 30 women) with the mean age of 48 years (range; 16100 years). 3D CT reconstructions were obtainedof all fractures, to allow an objective evaluation of the fracture pattern. A total of 46 patients were operated on and their intraoperative findings were correlated with 3D CT reconstructions. Scapular body fractures were deemed to be only those fractures that passed through the biomechanical body of the scapula, i.e. involved at least one of the pillars. Excluded from the study were fractures of the superior angle and of the superior border of the scapula as they were only marginal fractures leaving both pillars intact; scapular neck fractures defined as extra-articular two-part fractures of the lateral angle separating the glenoid from the scapular body; and fractures of the inferior angle of the scapula. Evaluation focused on the course of fracture lines, their relationship to the two pillars, and the number of fragments. A separate fragment was considered to be only such a fragment that carried part of the circumference of the biomechanical body. The intercalary fragmentsbroken off the central part of the infraspinous fossa were not included. RESULTS: We identified three basic groups of scapular body fractures, i.e. those involving only the spinal pillar, those involving only the lateral pillar and fractures affecting both pillars. Our series included 12 fractures of the spinal pillar, of these in 8 cases the main fracture line passed vertically from the supraspinous fossa of the central part of the pillar toward the medial border of the infraspinous fossa; in 4 cases the scapular spine base was broken off the scapular body. In all the cases, the lateral pillar was left intact and fragments were displaced only insignificantly. Therefore all these fractures were treated non-operatively. A total of 143 fractures involved the lateral pillar. All of them were fractures of the infraspinous portion of the scapular body, i.e. the infraspinous fossa, with the main fracture line propagating from the lateral pillar. This fracture pattern was divided on the basis of the number of circumference fragments into three subtypes, namely two-part (88), three-part (31) and comminuted (24) fractures. Fractures of both pillars were recorded in 32 cases. This fracture had two patterns, one (11 fractures) with a fracture line running through the spinal pillar close to the spinomedial angle to the superior angle of the scapula, and the other (21 fractures) with the main fracture line passing through the weakened central part of the scapular spine. This comminuted type was the most severe injury to the scapular body. The fracture line always propagated through the weakened central part of the spinal pillar. The fracture of the lateral pillar was displaced in all cases more than that of the spinal pillar. CONCLUSION: Classification of scapular body fractures based on involvement of the pillars of the scapular body is logical and simple. It always requires a 3D CT reconstruction, including subtraction of the surrounding bones. It respects the anatomical structure of the scapula and may serve also as a therapeutic guidance in preoperative planning.Key words: scapula scapula fractures scapular body fractures - classification classification of scapular body fractures.

[Classification of posterior malleolar fractures in ankle fractures]. / Klasifikace zlomenin zadní hrany tibie u zlomenin hlezna.

The study presents an overview of the most common radiography and CT-based classifications of posterior malleolar fractures in ankle fracture-dislocations. Their analysis has shown that posterior malleolar fractures largely vary in size and shape. Evaluation of fractures by plain radiographs is inadequate. A detailed assessment of the fragment shape and course of fracture lines requires CT examination in all three projections, followed by 3D CT reconstructions.Key words: ankle fracture - dislocations trimalleolar fractures posterior malleolar fractures classification.

Epidemiology of scapular fractures.

The aim of the study has been to acquire basic epidemiological data based on a representative group of patients with scapular fractures treated in one centre. The study analyses group of 250 patients. Diagnostics was based on CT examinations, in 227 cases with 3D reconstructions, in 97 cases compared with operative findings. Fractures were classified according to the modified anatomical classification of Tscherne and Christ. The analysed groups of patients include only the fracture lines whose existence has been verified by 3D CT reconstructions and intraoperative findings. The most common fracture in the group was that of the scapular body (52%), followed by fractures of the glenoid fossa (29%), fractures of the processes (11%) and fractures of the scapular neck (8%). The most frequent associated injuries to the ipsilateral shoulder girdle were clavicular fractures (19%). Scapular fractures occur primarily in men, predominantly in 4th - 6th decades (66 % patients). The group of women was significantly older as compared to men (p = 0.017). The group of patients with scapular neck fractures was significantly younger as compared to the age of patients with glenoid fracture (p = 0.021) and scapular body fracture (p = 0.035).

Total glenoid fractures.

INTRODUCTION: Fractures affecting the entire glenoid fossa are termed comminuted or total glenoid fractures. However, there are no detailed studies of total glenoid fractures, and only brief mentions can be found in the literature. METHODS: The group comprised 12 patients (mean age, 39 years), who sustained 13 fractures of the glenoid fossa. In all the fractures, all parts of the glenoid fossa were separated from the scapular neck or body. In total 5 patients (6 fractures) were treated non-operatively and 7 patients were operated on. The method of treatment was based on displacement of the fragments, the patient´s general and local conditions. Indication for operative treatment was displacement of articular fragments of more than 3mm. This criterion was met by 10 patients (11 fractures). Owing to the general or local condition, operation was contraindicated in 2 patients with 3 fractures; one patient refused the operation. One patient with a bilateral fracture was lost to follow-up. RESULTS: According to the site of separation of articular fragments, the fractures were divided into three groups - the separation line passed through the anatomical neck; through the coracoid process or surgical neck of the scapula; or through the scapular body. In 6 of the 7 operated patients, a good or very good result was achieved. In 2 patients with minimal fragment dislocation treated non-operatively, the fractures healed in an anatomical position and full range of motion was achieved. In 2 patients with severe fragment displacement treated non-operatively, the healing resulted in glenoid fossa incongruence and painful and limited range of motion. CONCLUSION: Fractures of the entire glenoid fossa are the most severe injuries to scapula. Their diagnosis requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment from the Judet approach.Key words: scapular fractures glenoid fractures classification, operative treatment Judet approach.

Amino phenolics from the fruit of the argan tree Argania spinosa (Skeels L.).

A new phenolic-type compound containing a nitrogenous, heterocyclic-fused ring from the fruit of the argan tree, Argania spinosa (Skeels L.), is described. This and another already known compound also isolated in the course of the work belong to an obscure and rare class of natural products, the amino phenolics.

[CT diagnostics of scapular fractures]. / CT - diagnostika zlomeniny lopatky.

INTRODUCTION: The aim of the study was to determine the relevance of CT examination in scapular fractures and to standardize it. MATERIAL AND METHODS: A group of 163 patients with extra-articular fracture of the scapular body and neck was analysed. 3D CT was performed in 85 of them and 31 patients were operated on. This group served as the basis for evaluating the benefits of CT examination for the diagnostics of scapular fractures. RESULTS: CT scans are very helpful for the evaluation of the glenoid fossa and, where necessary, of the processes of the scapula. They, however, do not allow for a correct determination of the fracture types, those of the scapular body and neck in particular. Three-dimensional CT (3D CT) reconstruction is the only method allowing for the determination of the exact types of scapula fracture. In these reconstructions it is necessary to image the scapula from three standardized views, i.e. from posterior, anterior and lateral aspects, after subtraction of the ribs, the proximal humerus and the clavicle. CONCLUSION: All fractures of the scapular body and neck require 3D CT reconstruction.