Movimiento escapular, distancia acromiohumeral, rango y fuerza rotacional glenohumeral en deportistas femeninas de handball de élite / Scapular motion, acromiohumeral distance, range and glenohumeral rotational strength in elite female handball athletes

Antecedentes: El handball es un deporte "overhead" que expone al hombro a demandas elevadas de carga durante la práctica, lo que puede llevar a esta articulación a sufrir adaptaciones específicas. La comprensión de estas adaptaciones es importante y puede ayudar a los clínicos a crear protocolos de prevención y a desarrollar programas de condicionamiento y rehabilitación para esta población. Objetivos: Generar un perfil descriptivo de:1) movimiento escapular durante la elevación y descenso de la extremidad superior en el plano escapular, 2) distancia acromiohumeral y 3) rango de movimiento y fuerza rotacional glenohumeral en deportistas femeninas de handball de élite. Métodos: Se realizo un estudio transversal observacional y descriptivo en 23 jugadoras (Edad = 22±4.3 años; Años de practica 9.7±3.5) de handball de élite, libres de dolor. Se valoró el movimiento escapular bilateral durante la elevación y el descenso del brazo, la distancia acromiohumeral durante la abducción activa y pasiva, y el rango de movimiento articular y la fuerza rotacional GH en rotación interna y externa. Se describen estas variables, comparándolas entre ambos brazos, y entre los grupos formados en función del déficit de rotación interna GH. Resultados: No se detectaron diferencias significativas en el movimiento escapular 3D ni en la distancia acromiohumeral entre los brazos. Se observó una disminución del rango de rotación interna (Diferencia Media (DM)= -11.09°; Intervalo Confianza 95% (IC)= -17.70,-4.47) y un incremento del rango de rotación externa (DM= 12.82°; IC= 6.07°,19.58°) en el hombro dominante. El torque rotacional GH en rotación externa fue mayor (DM= 0.36 Nm/kg; IC=-0.008 Nm/kg, -0.81Nm/kg) en el hombro dominante. Las participantes con déficit de rotación interna mostraron mayores rangos de rotación superior y tilt posterior escapular durante la elevación, mayor distancia acromiohumeral en reposo y mayor disminución de esta durante la elevación de la extremidad Conclusión: Los resultados sugieren que no existen diferencias en el movimiento escapular durante la elevación y descenso de la extremidad superior, ni en la distancia acromiohumeral en las diferentes posiciones de elevación GH activa y pasiva entre el brazo dominante y no dominante de las deportistas femeninas de handball de élite. Los hallazgos indican que el brazo lanzador de estas deportistas presenta diferencias en el rango rotacional y en la fuerza, que podrían representar un factor de riesgo lesional, siendo detectables en el ambiente clínico. Las deportistas que presentan GIRD, muestran mayor movimiento escapular 3D durante la elevación, mayor DAH en reposo y mayor disminución de esta durante la elevación de la ES

Background: Handball is an overhead sport that exposes the shoulder to high demands of load during the practice, which may lead this joint to sport-specific adaptions. Understanding these adaptions is important and may help clinicians to create preventive protocols and further develop conditioning and rehabilitation program to this population. Objectives: To generate a descriptive profile of:1) scapular motion during upper extremity raising and lowering along the scapular plane, 2) acromiohumeral distance, and 3) GH rotational range of motion and rotational strength in elite female handball athletes. Methods: This is observational and descriptive cross-sectional study. Twenty-three (22±4.3 years and 9.7±3.5 years of practice) pain free elite female handball players were assessed. Outcome measures included bilateral 3D scapular movement during raising and lowering of the arm, acromiohumeral distance during passive and active abduction, GH range of motion of internal and external rotation, and strength of the internal and external rotators. These variables were described by comparing them between both arms, and among the groups according to the GH internal rotation deficit. Results: No significant differences were detected in 3D scapular motion or acromiohumeral distance between the arms. A decrease in internal rotation range of motion (Mean Difference (MD) =-11.09°;95% Confidence Interval (CI)= -17.70°, -4.47°) and an increase in external rotation range of motion (MD= 12.82°; CI=6.07°, 19.58°) and in GH rotational torque in external rotation (MD=0.36 Nm/kg; CI=-0.008Nm/kg, -0.81Nm/kg) were observed in the dominant shoulder. Participants with internal rotation deficit showed greater ranges of superior rotation and scapular posterior tilt during raising, greater acromiohumeral distance at rest and greater decrease of this during limb elevation. Conclusion: The findings suggest there are no differences in in the scapular movement during upper extremity raising and lowering along the scapular plane, nor in the acromiohumeral distance during passive and active GH between the dominant and non-dominant arm of elite female handball athletes. The findings indicate that there are differences in rotational range of motion and strength between both arms, which could represent an injury risk factor, being detectable in the clinical sports environment. Participants with internal rotation deficit showed greater scapular 3D movement, greater DAH at rest and greater decrease of it during arm elevation

Caracterización epidemiológica de pacientes operados por fractura de escápula en Hospital Traumatológico de Concepción durante los años 2019-2022 / Epidemiological characteristics of patients operated for scapular fracture at Hospital Traumatologico de Concepción during the years 2019-2022

Introducción: Las fracturas de escápula tienen una baja frecuencia, se presentan mayoritariamente en población joven tras traumatismos de alta energía. Su tratamiento historicamente ha sido conservador, sin embargo, el tratamiento quirúrgico ha demostrado mejores resultados funcionales en pacientes seleccionados, siendo la indicación quirúrgica aún controversial. La literatura sobre los pacientes tratados de forma quirúrgica es escasa. Objetico general: Caracterizar a los pacientes operados por fractura de escapula en Hospital Traumatológico de Concepción durante los años 2019-2022. Materiales y métodos: Estudio descriptivo que incluye a pacientes operados por fractura de escápula en el Hospital Traumatológico de Concepción durante los años 2019 al 2022, considerando las variables sexo, edad, lateralidad, mecanismo de lesión y lesiones asociadas. Resultados: Se estudiaron 20 pacientes de los cuales 90% fueron hombres, registrándose un promedio de edad de 41 años, sin diferencias significativas en su lateralidad. Los principales mecanismos de lesión fueron accidentes de tránsito y caídas de altura, existiendo lesiones asociadas sólo en 45% de los casos. Conclusión: Las fracturas de escápula tienen alto impacto en la funcionalidad de la extremidad afectada, por lo que su tratamiento hoy en día esta evolucionando hacia uno quirúrgico en pacientes seleccionados, con el fin de obtener mejores resultados funcionales. Los pacientes operados son mayoritariamente adultos de edad media de sexo masculino, con fracturas secundarias a traumatismos de alta energía y presencia de lesiones asociadas de baja morbimortalidad.

Introduction: Scapula fractures have a low frequency. They occur mainly in the young population after high-energy trauma. Its treatment has historically been conservative; however, surgical treatment has shown better functional results in selected patients, the surgical indication being still controversial. The literature on patients treated surgically is scarce. General Objective: Characterize the patients operated on for scapular fracture at the Hospital Traumatológico de Concepción during the years 2019-2022. Materials and methods: Descriptive study that includes patients operated on for scapula fracture at the Concepción Trauma Hospital during the years 2019 to 2022, considering the variables sex, age, laterality, mechanism of injury and associated injuries. Results: Twenty patients were studied, of whom 90% were men, recording an average age of 41 years, with right scapula fracture being slightly more frequent than left. The main mechanisms of injury were traffic accidents and falls from a height, with associated injuries only in 45% of the cases. Conclusion: Scapula fractures have a high impact on the functionality of the affected limb, so their treatment today is evolving towards surgery in selected patients, in order to obtain better functional results. The patients operated on are mostly middle-aged male adults, with fractures secondary to high-energy trauma and the presence of associated lesions with low morbidity and mortality.

A Simple Bone Cyst of the Acromion: Case Report / Cisto ósseo simples do acrômio: Relato de caso

Abstract Simple bone cysts rarely occur in the scapula, and, to our knowledge, they have not been reported in the acromion. In the present report, we present the case of a 24-year-old female patient who was successfully treated by curettage and grafting using xenografting. No recurrence findings were observed during the follow-up six months postoperatively, the patient had recovered full range of motion, and she was able to perform all routine activities satisfactorily.

Resumo Cistos ósseos simples são raros na escápula, e, pelo que sabemos, não foram relatados no acrômio. Aqui, apresentamos uma paciente do sexo feminino, de 24 anos, submetida com sucesso ao tratamento composto por curetagem e xenoenxerto. Não foram observados achados de recidiva no acompanhamento pós-operatório de seis meses, quando a paciente apresentou amplitude total de movimento e foi capaz de realizar todas as atividades rotineiras de maneira satisfatória.

Scapulothoracic dissociation and blunt vertebral vascular injury: case report / > Disociación escapulo-torácica y trauma cerrado de arteria vertebral: reporte de un caso

Abstract Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

Resumen Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

Scapulothoracic dissociation and blunt vertebral vascular injury: case report.

CASE DESCRIPTION: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. CLINICAL FINDINGS: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. TREATMENT AND OUTCOME: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae. CLINICAL RELEVANCE: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

DESCRIPCIÓN DEL CASO: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. HALLAZGOS CLÍNICOS: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. TRATAMIENTO Y RESULTADO: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. RELEVANCIA CLÍNICA: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

Manejo quirúrgico de fracturas extraarticulares de la escápula. Reporte de caso y revisión de literatura / Surgical treatment of an extraarticular scapula fracture. Case report and literature review

Resumen: Introducción: Las fracturas escapulares comprenden 1% del total de las fracturas en general y de 3 a 5% del hombro, las cuales se presentan por alta energía en pacientes jóvenes. Sólo 10% tiene indicación quirúrgica al tomarse como base la alteración de complejo suspensorio del hombro. El objetivo es valorar el resultado de pacientes con indicación quirúrgica así como una revisión de la literatura. Reporte de casos: Presentamos dos pacientes con fractura del cuerpo escapular derecho Bartonicek D con desplazamiento mediolateral, deformidad angular anteroposterior y alteración del ángulo glenopolar. Se realizó el manejo quirúrgico con osteosíntesis y placas convencionales y anatómicas. Se realizó valoración funcional y seguimiento radiográfico de ambos casos a los seis meses y se obtuvo arcos de movilidad flexión 180o/170o en ambos casos, así como escalas funcionales DASH 22/25, Constant 90/89 y Simple Shoulder Test 11/11 respectivamente; se obtuvo una consolidación ósea grado III-IV de Montoya. Discusión: Se considera importante realizar una adecuada reducción y estabilización del trazo de fractura debido al bajo grado de satisfacción con tratamiento conservador en pacientes con alta demanda funcional, que consiste en dolor residual, pinzamiento y disquinesia escapular. Se recomienda la cirugía para estas fracturas ya que comprometen la cadena cinética del hombro e impactan en el resultado funcional a corto y mediano plazo.

Abstract: Introduction: Scapular fractures comprise 1% of all fractures and 3 to 5% of the shoulder, they occur in young patients by high energy trauma. Only 10% have surgical indication based on the alteration of the shoulder's suspensory complex. The objective is to assess the outcome of patients with surgical indication as well as a review of the literature. Case report: We present two patients with Bartonicek D fracture of the right scapular body with mediolateral displacement, anteroposterior angular deformity and alteration of the glenopolar angle. Surgery was performed on both cases with conventional and special anatomical plates. Functional assessment and radiographic follow-up of both cases were performed at 6 months, obtaining flexion mobility of 180º/170º in both cases, as well as functional scales DASH 22/25, Constant 90/89 and Simple Shoulder Test 11/11 respectively; with bone consolidation grade III-IV of Montoya. Discussion: Due to the low degree of satisfaction with conservative treatment in patients with high functional demand, and multiple complications consisting in residual pain, impingement and scapular dyskinesia; it is important to perform an adequate reduction and stabilization of the fracture. We recommend surgical management for this type of fractures since they compromise the kinetic chain of the shoulder and impact the functional outcome in the short and medium term.

[Surgical treatment of an extraarticular scapula fracture. Case report and literature review]. / Manejo quirúrgico de fracturas extraarticulares de la escápula. Reporte de caso y revisión de literatura.

INTRODUCTION: Scapular fractures comprise 1% of all fractures and 3 to 5% of the shoulder, they occur in young patients by high energy trauma. Only 10% have surgical indication based on the alteration of the shoulders suspensory complex. The objective is to assess the outcome of patients with surgical indication as well as a review of the literature. CASE REPORT: We present two patients with Bartonicek D fracture of the right scapular body with mediolateral displacement, anteroposterior angular deformity and alteration of the glenopolar angle. Surgery was performed on both cases with conventional and special anatomical plates. Functional assessment and radiographic follow-up of both cases were performed at 6 months, obtaining flexion mobility of 180º/170º in both cases, as well as functional scales DASH 22/25, Constant 90/89 and Simple Shoulder Test 11/11 respectively; with bone consolidation grade III-IV of Montoya. DISCUSSION: Due to the low degree of satisfaction with conservative treatment in patients with high functional demand, and multiple complications consisting in residual pain, impingement and scapular dyskinesia; it is important to perform an adequate reduction and stabilization of the fracture. We recommend surgical management for this type of fractures since they compromise the kinetic chain of the shoulder and impact the functional outcome in the short and medium term.

INTRODUCCIÓN: Las fracturas escapulares comprenden 1% del total de las fracturas en general y de 3 a 5% del hombro, las cuales se presentan por alta energía en pacientes jóvenes. Sólo 10% tiene indicación quirúrgica al tomarse como base la alteración de complejo suspensorio del hombro. El objetivo es valorar el resultado de pacientes con indicación quirúrgica así como una revisión de la literatura. REPORTE DE CASOS: Presentamos dos pacientes con fractura del cuerpo escapular derecho Bartonicek D con desplazamiento mediolateral, deformidad angular anteroposterior y alteración del ángulo glenopolar. Se realizó el manejo quirúrgico con osteosíntesis y placas convencionales y anatómicas. Se realizó valoración funcional y seguimiento radiográfico de ambos casos a los seis meses y se obtuvo arcos de movilidad flexión 180o/170o en ambos casos, así como escalas funcionales DASH 22/25, Constant 90/89 y Simple Shoulder Test 11/11 respectivamente; se obtuvo una consolidación ósea grado III-IV de Montoya. DISCUSIÓN: Se considera importante realizar una adecuada reducción y estabilización del trazo de fractura debido al bajo grado de satisfacción con tratamiento conservador en pacientes con alta demanda funcional, que consiste en dolor residual, pinzamiento y disquinesia escapular. Se recomienda la cirugía para estas fracturas ya que comprometen la cadena cinética del hombro e impactan en el resultado funcional a corto y mediano plazo.

Surgical stabilization of canine lateralscapulohumeral luxation using extracapsular tension suture with screws and nylon wire – case report

A dog was consulted with functional disability of the right thoracic limb.Radiographic image showed lateral luxation of the scapulohumeral joint.The animal was submitted to surgical treatment using tension suture withscrews and Nylon wire, with satisfactory result and functional use of thelimb 30 days postoperatively.

Surgical stabilization of canine lateralscapulohumeral luxation using extracapsular tension suture with screws and nylon wire case report

A dog was consulted with functional disability of the right thoracic limb.Radiographic image showed lateral luxation of the scapulohumeral joint.The animal was submitted to surgical treatment using tension suture withscrews and Nylon wire, with satisfactory result and functional use of thelimb 30 days postoperatively.(AU)

Atrofia de los músculos supra y infraspinoso debido lesiones en el nervio supraescapular en equino (Sweeny) / Atrophy of the supra and infraspinatus muscles due to injury of the suprascapular nerve in horse (Sweeny) / Atrofia dos músculos supra e infra espinhoso por lesão do nervo supraescapular em equino (Sweeny)

Se presenta un caso de atrofia de los músculos supra y infraespinosos por el daño del nervio supraescapular comúnmente llamado "Sweeny" en un caballo, mestizo, macho, castrado, de 15 años de edad, con un peso de 350 kg, que se utiliza para la tracción, asistimos en el Hospital Clínicas veterinarias (HCV) de Centro de Ciencias Agroveterinarias (CAV) de la Universidad del Estado de Santa Catarina (UDESC), Lages, SC, Brasil. El animal mostró signos clínicos tales como la atrofia muscular de la región limitada por los músculos que se llenan los tanques de la escápula y la inestabilidad moderada de la articulación del hombro del húmero de la extremidad anterior izquierda, que se encuentran en movimiento durante la inspección. Debido a los cambios crónicos e irreversibles en la musculatura y estable, no traen más daño al animal, se decidió no iniciar ningún tratamiento y recomendó al propietario reduce la carga de trabajo y la adecuación de guarnicionería utilizado en el animal. Esta es la primera discreción clínica en Brasil atrofia de la lesión muscular arriba y infraespinoso al nervio supraescapular con evolución crónica en equinos.

This is a case report of atrophy of the shoulder muscles (sweeny) supra and infraspinatus due to suprascapular nerve injury in a horse, cross breed, male, with 15 years of age, weigh 350 kg, used for traction, seen at the Veterinary Hospital (HCV) from the Santa Catarina State University (UDESC), Agroveterinary Sciences Center (CAV) from Lages, SC, Brazil. The animal showed clinical signs such as muscle atrophy of the scapular region and moderate instability of the shoulder joint of the left forelimb. Due to chronic and irreversible changes in the musculature, with no further complications to the animal, treatment was based on reducing workload and suitability of tack used in the animal. This is the first clinical description in Brazil of atrophy of the supra and infraspinatus muscles due to injury of the suprascapular nerve with chronic presentation.

Relata-se um caso de atrofia dos músculos supra e infraespinhoso por lesão do nervo supraescapular comumente denominada Sweeny, em um equino, mestiço, macho, castrado, de 15 anos de idade, pesando 350 kg, utilizado para tração, atendido no Hospital de Clínicas Veterinárias (HCV) do Centro de Ciências Agroveterinárias (CAV) da Universidade do Estado de Santa Catarina (UDESC), Lages, SC, Brasil. O animal apresentava como sinais clínicos a atrofia muscular da região delimitada pelos músculos que preenchem as fossas escapulares e moderada instabilidade da articulação escapulo umeral do membro torácico esquerdo, constatado durante inspeção em movimento. Devido à cronicidade, as alterações irreversíveis na musculatura e ao quadro estável, não trazendo maiores prejuízos ao animal, optou-se por não instaurar qualquer tratamento e recomendou-se ao proprietário a redução da carga de trabalho e adequação do arreamento utilizado no animal. Trata-se da primeira descrição clínica no Brasil de atrofia dos músculos supra e infraespinhoso por lesão ao nervo supraescapular de evolução crônica em equino.

Atrofia de los músculos supra y infraspinoso debido lesiones en el nervio supraescapular en equino (Sweeny) / Atrophy of the supra and infraspinatus muscles due to injury of the suprascapular nerve in horse (Sweeny) / Atrofia dos músculos supra e infra espinhoso por lesão do nervo supraescapular em equino (Sweeny)

Se presenta un caso de atrofia de los músculos supra y infraespinosos por el daño del nervio supraescapular comúnmente llamado "Sweeny" en un caballo, mestizo, macho, castrado, de 15 años de edad, con un peso de 350 kg, que se utiliza para la tracción, asistimos en el Hospital Clínicas veterinarias (HCV) de Centro de Ciencias Agroveterinarias (CAV) de la Universidad del Estado de Santa Catarina (UDESC), Lages, SC, Brasil. El animal mostró signos clínicos tales como la atrofia muscular de la región limitada por los músculos que se llenan los tanques de la escápula y la inestabilidad moderada de la articulación del hombro del húmero de la extremidad anterior izquierda, que se encuentran en movimiento durante la inspección. Debido a los cambios crónicos e irreversibles en la musculatura y estable, no traen más daño al animal, se decidió no iniciar ningún tratamiento y recomendó al propietario reduce la carga de trabajo y la adecuación de guarnicionería utilizado en el animal. Esta es la primera discreción clínica en Brasil atrofia de la lesión muscular arriba y infraespinoso al nervio supraescapular con evolución crónica en equinos.(AU)

This is a case report of atrophy of the shoulder muscles (sweeny) supra and infraspinatus due to suprascapular nerve injury in a horse, cross breed, male, with 15 years of age, weigh 350 kg, used for traction, seen at the Veterinary Hospital (HCV) from the Santa Catarina State University (UDESC), Agroveterinary Sciences Center (CAV) from Lages, SC, Brazil. The animal showed clinical signs such as muscle atrophy of the scapular region and moderate instability of the shoulder joint of the left forelimb. Due to chronic and irreversible changes in the musculature, with no further complications to the animal, treatment was based on reducing workload and suitability of tack used in the animal. This is the first clinical description in Brazil of atrophy of the supra and infraspinatus muscles due to injury of the suprascapular nerve with chronic presentation.(AU)

Relata-se um caso de atrofia dos músculos supra e infraespinhoso por lesão do nervo supraescapular comumente denominada Sweeny, em um equino, mestiço, macho, castrado, de 15 anos de idade, pesando 350 kg, utilizado para tração, atendido no Hospital de Clínicas Veterinárias (HCV) do Centro de Ciências Agroveterinárias (CAV) da Universidade do Estado de Santa Catarina (UDESC), Lages, SC, Brasil. O animal apresentava como sinais clínicos a atrofia muscular da região delimitada pelos músculos que preenchem as fossas escapulares e moderada instabilidade da articulação escapulo umeral do membro torácico esquerdo, constatado durante inspeção em movimento. Devido à cronicidade, as alterações irreversíveis na musculatura e ao quadro estável, não trazendo maiores prejuízos ao animal, optou-se por não instaurar qualquer tratamento e recomendou-se ao proprietário a redução da carga de trabalho e adequação do arreamento utilizado no animal. Trata-se da primeira descrição clínica no Brasil de atrofia dos músculos supra e infraespinhoso por lesão ao nervo supraescapular de evolução crônica em equino.(AU)

Fixação perpendicular com dupla-placa e sistema de bloqueio para fratura de pedículo do acrômio / Perpendicular double-plate fixation with locking system for acromion pedicle fracture

Objetivo: Descrever a técnica cirúrgica e os resultados clínicos preliminares em uma série de cirurgias de redução aberta e fixação interna de fraturas do processo acrômio basais aplicando a técnica de dupla placa. Métodos: Nove pacientes consecutivos, com idade média de33,4 anos (intervalo, 23-61 anos) com fratura unilateral do acrômio (Tipo 3 AO/OTA) com mais de 1 cm de deslocamento submetidos afixação utilizando uma técnica de dupla placa bloqueada, tiveram os resultados avaliados em média após 7,8 meses (intervalo, 3-15 meses)referente à dor, função do ombro, e complicações cirúrgicas. Resultados:Oito pacientes se recuperaram com união radiográfica completa e função do ombro favorável. Um caso deixou de ser completamente avaliado por mais de 3 meses de seguimento. Os escores totais de Constant, dor no ombro e Disability Index (SPADI) e DASH para os oito pacientes revistos foram 91,9 ± 6,31, 3,11 ± 3,79 e 5,2 ± 6,35,respectivamente. Não houve infecção ou irritação decorrente das ferragens cirúrgicas no pós-operatório ao final do seguimento destes oito pacientes. Conclusão: Apesar de serem necessárias mais evidências para justificar suas vantagens sobre os implantes tradicionais, a dupla placa perpendicular com sistema de bloqueio pode ser indicada para tratamento de fratura do pedículo do acrômio, uma vez que apresentou bom desempenho na cicatrização óssea e reabilitação da função articular. Nível de Evidência IV, Estudo Terapêutico.

Objective: To describe the surgical technique and preliminaryclinical outcomes in a series of open reduction internal fixationof basal acromion process fractures applying a double-platingtechnique. Methods: Nine consecutive patients, mean age 33.4years old (range, 23–61 years old) with unilateral acromion fracture(Type 3 AO/OTA) with more than 1cm displacement whounderwent fixation utilizing a locked double-plating technique,were evaluated on average at 7.8 months (range, 3-15 months)for outcomes related to pain, shoulder function, and surgicalcomplications. Results: Eight patients recovered with complete radiographicunion and favorable shoulder function. One case failedto be fully evaluated for more than 3 months follow-up. The overallscores of Constant, Shoulder Pain and Disability Index (SPADI)and DASH for the eight patients reviewed were 91.9± 6.31, 3.11±3.79 and 5.2± 6.35, respectively. No post-operative infection orsurgical hardware irritation was identified at final follow-up ofthese eight patients. Conclusion: While more evidence is neededto justify its advantages over traditional implants, perpendiculardouble-plate with a locking system may be indicated for acromionpedicle fracture treatment, since it performed well for fracturehealing and joint function rehabilitation. Level of Evidence IV,Therapeutic Study.

Pomada à base de sulfanilamida e óleo de fígado de bacalhau favorece a cicatrização de feridas cutâneas em equino / Ointment composed by sulfanilamide and cod liver oil favours the healing process of cutaneous wounds in horse / Pomada compuesta por sulfanilamida y aceite de hígado de bacalao favorece la cicatrización de heridas cutáneas en caballo"

El objetivo de este estudio fue relata el proceso de cicatrización en una yegua de, que sufrió un heridas el antímero izquierdo. Para el tratamiento de Ias heridas se optó por el uso de Ia pomada POMADOL ® a base de sulfanilamida, oxido de zinc, alcanfor y aceite de hígado de bacalao. A partir de los resultados observados donde es posible notar Ia evoluciónde Ia lesiónen 30 días. Se destaca que durante el tratamiento, Ias heridas presentaron pocotejido de granulación y Ia infección se mantuvo controlada 10 que facilitó Ia reparación tecidual en corto periódo de tiempo. Se concluye que el uso de Ia pomada utilizada fue eficaz en eltratamiento de heridas por segunda intención extensas y contaminadas, presentando buena evolución cicatricial.

The aim of this study was to report the healing processon amare affected by two wounds on the left scapula. For the treatment was used ointment composed by sulfanilamide,zinc oxide, camphor and cod liver oil (POMADOL®). Applied twice a day for 30 days. It was observed the evolution in 30 days and they showed little granulation tissue and low infection, which facilitated the healing in short period. We concluded that the use this ointment product proved to be effective to treat of wounds for secondary intention extensive and contaminated, with good healing process evolution.

O objetivo deste trabalho foi relatar o processo de cicatrização em uma égua afetada por duas feridas na escápula esquerda. Para o tratamento foi utilizada uma pomada constituída por sulfanilamida, óxido de zinco, cânfora e óleo de fígado de bacalhau(POMADOL®). Foi aplicada duas vezes por dia durante 30 dias. Observou-se a evolução em 30 dias, as feridas mostraram pouco tecido de granulação e baixa infecção, o que facilitou a cicatrização em curto período. Concluímos que o uso desta pomada é eficaz no tratamento de feridas por segunda intenção extensa e contaminada, com boa evolução no processo de cicatrização.

Pomada à base de sulfanilamida e óleo de fígado de bacalhau favorece a cicatrização de feridas cutâneas em equino / Ointment composed by sulfanilamide and cod liver oil favours the healing process of cutaneous wounds in horse / Pomada compuesta por sulfanilamida y aceite de hígado de bacalao favorece la cicatrización de heridas cutáneas en caballo"

El objetivo de este estudio fue relata el proceso de cicatrización en una yegua de, que sufrió un heridas el antímero izquierdo. Para el tratamiento de Ias heridas se optó por el uso de Ia pomada POMADOL ® a base de sulfanilamida, oxido de zinc, alcanfor y aceite de hígado de bacalao. A partir de los resultados observados donde es posible notar Ia evoluciónde Ia lesiónen 30 días. Se destaca que durante el tratamiento, Ias heridas presentaron pocotejido de granulación y Ia infección se mantuvo controlada 10 que facilitó Ia reparación tecidual en corto periódo de tiempo. Se concluye que el uso de Ia pomada utilizada fue eficaz en eltratamiento de heridas por segunda intención extensas y contaminadas, presentando buena evolución cicatricial.(AU)

The aim of this study was to report the healing processon amare affected by two wounds on the left scapula. For the treatment was used ointment composed by sulfanilamide,zinc oxide, camphor and cod liver oil (POMADOL®). Applied twice a day for 30 days. It was observed the evolution in 30 days and they showed little granulation tissue and low infection, which facilitated the healing in short period. We concluded that the use this ointment product proved to be effective to treat of wounds for secondary intention extensive and contaminated, with good healing process evolution.(AU)

O objetivo deste trabalho foi relatar o processo de cicatrização em uma égua afetada por duas feridas na escápula esquerda. Para o tratamento foi utilizada uma pomada constituída por sulfanilamida, óxido de zinco, cânfora e óleo de fígado de bacalhau(POMADOL®). Foi aplicada duas vezes por dia durante 30 dias. Observou-se a evolução em 30 dias, as feridas mostraram pouco tecido de granulação e baixa infecção, o que facilitou a cicatrização em curto período. Concluímos que o uso desta pomada é eficaz no tratamento de feridas por segunda intenção extensa e contaminada, com boa evolução no processo de cicatrização.(AU)

Disociación escapulotorácica traumática: una entidad para tener en cuenta en caso de trauma / Traumatic scapulothoracic dissociation: an entity to be considered in case of trauma

Traumatic scapulothoracic dissociation represents the separation of the scapula from the chest wall. The mechanism of this trauma involves a severe traction applied to the upper member which translates into neurovascular and musculoskeletal injuries secondary to trauma. This lesion often goes unnoticed for appearing in conjunction with major trauma or presenting with bizarre symptoms. On physical examination, patients exhibit swelling of soft tissue around the shoulder and upper limb. Lateral displacement of scapula greater than 1 cm is the classic radiological finding on thoracic imaging studies. The key is to compare the distance from medial borders of the scapula to midline (dorsal column).

La disociación escapulotorácica traumática como su nombre lo indica, se define como la separación de la escápula de la pared del tórax. El mecanismo de este trauma implica una tracción severa aplicada al miembro superior con lesiones neurovasculares y musculoesqueléticas secundarias. Esta lesión suele pasar desapercibida por presentarse en conjunto con traumas mayores o cursar con síntomas bizarros. Al examen físico, los pacientes presentan edema de tejidos blandos alrededor del hombro y de la parte superior de la extremidad. El hallazgo radiológico clásico en la radiografía de tórax es el desplazamiento lateral mayor a 1 cm de la escápula con respecto al tórax. La clave está en comparar la distancia de los bordes mediales de las escápulas en relación a una línea media en la columna dorsal.

Análisis del tratamiento quirúrgico de las fracturas de escápula / Analysis of surgical treatment of fractures of the scapula

Las fracturas Escapulares han recibido poca atención en la literatura ya que son lesiones poco frecuentes y que evolucionan bien con el tratamiento conservador. Entre el año 2000 y 2008, se intervinieron quirúrgicamente 21 fracturas, en pacientes con edad promedio de 34,5 años, con un seguimiento posterior de 17 pacientes por un promedio de tiempo de 57.5 meses. El material utilizado fueron las placas de reconstrucción de bajo perfil de 2.7 mm y de 3.5 mm de diámetro. El abordaje utilizado fue vía posterior. No se presentaron complicaciones post operatorias y se instauró rehabilitación fisiátrica precoz. Se valoró a los pacientes con la escala de Constant, obteniendo resultados excelentes de 76.5% (13 casos) y buenos de 23.5% (4 casos). Con estos resultados se concluye que el tratamiento quirúrgico de las fracturas de escápula inestables es una indicación segura y eficaz para la buena evolución clínica y funcional de estas lesiones

Scapular Fractures have received little attention in the literature since these injuries are rare and have a good outcome with conservative treatment. Between 2000 and 2008, 21 fractures were treated surgically in patients with an average age of 34.5 years, with a subsequent follow-up of 17 patients for an average time of 57.5 months. The material used where low profile reconstruction plates 2.7 mm and 3.5 mm in diameter.We used the posterior approach in all cases, there were no complications and the post-operative rehabilitation was established early. All patients were evaluated by the Constant scale with 76.5% (13 cases) excellentresultsand 23.5% (4 cases) good results. We concluded that the surgical treatment of scapular unstable fracturesis safe and effective indication to restore excellent function of the shoulder

Exact moment of bilateral scapular fracture during skydiving captured on video.

A skydiving athlete suffered bilateral scapular fracture while jumping from the plane. A camera showed the exact moment of fracture. The injury seemed to occur during hyperextension of the arms; however, the most common mechanism of fracture is during direct trauma of the shoulder. The patient was treated by immobilisation with a sling for 3 weeks and had a good outcome. Clinical and radiographic consolidation occurred 8 weeks after the injury. The athlete returned to competitive activities after 4 months.

Fratura da escápula: resultados do tratamento cirúrgico em 15 pacientes / Scapula fractures: outcomes after surgical treatment in 15 patients

OBJETIVO: Apresentar os resultados do tratamento cirúrgico de 15 pacientes com fratura da escápula. MÉTODOS: Avaliação retrospectiva dos resultados clinicos e radiográficos do tratamento cirurgico de fraturas da escápula, em um periodo de dez anos. A avaliação clínica baseou-se tanto no escore de Schofer et al. quanto no Constant-Murley. Na avaliação radiográfica, pesquisou-se a existência de perda da redução, pseudartrose ou alterações póstraumáticas. A análise estatística foi puramente descritiva, por meio de cálculo percentual dos achados. RESULTADOS: Todas as fraturas consolidaram em um período médio de 90 dias, confor- me documentação radiográfica. Na última consulta ambulatorial, o tempo médio de seguimento foi de 45,6 meses (variando de 14 a 109,2 meses). Nenhum paciente referiu dor constante e incapacitante no ombro operado. O escore médio de Constant- Murley foi de 84 pontos (variando de 76 a 90 pontos). Dos 15 pacientes, 13 (86,7 por cento) retornaram ao nível funcional prévio sem restrição (atividades profissional e recreacionais). Não forma detectados sinais de perda de redução, pseudartrose ou osteo- artrose pós-traumática. Não ocorreram penetração ou impacto articular pela presença do material de osteossíntese. CONCLUSÃO: Em pacientes com fraturas da escápula, que se enquadrem nos critérios para tratamento cirúrgico, os resultados são bons desde que sejam respeitados os tecidos moles periarticulares e realizado o devido planejamento da via de acesso e do protocolo de reabilitação.

OBJECTIVE: To evaluate the clinical and radiographic outcomes on 15 unstable scapula fractures treated by open reduction and internal fixation. METHODS: A retrospective study to evaluate the results of scapula fracture fixation in 15 patients, managed at our Institution during a 10-year period. Shoulder function was recorded in both upper extremities with both the Schofer et al. and the Constant-Murley score. Radiographic analysis was done in terms of loss of reduction, nonunion, and post-traumatic degenerative changes. Statistical analysis was purely descriptive with calculation of percentage. RESULTS: All fractures healed in a mean of 90 days, as documented by simple radiographs. At the last consultation, the mean follow-up was 45.6 months (ranging from 14 to 109,2 months). No patient had constant pain or referred incapacity. The mean Constant- Murley score for the 15 patients was 84 points (ranging from 76 to 90 points). Of the 15 patients, 13 (86.7 percent) had returned to their previous employment and recreational activities with- out restrictions. No signs of loss of reduction, nonunion, or post-traumatic degenerative changes were seen. In addition, no ardware impingement or articular penetration was observed in any case. CONCLUSION: The respect to the soft tissue is the cornerstone of proper treatment of this scapular fractures. In our series good results were obtained when appropriate preoperative planning and post-operative rehabilitation has been performed.

Fracture dislocation of the glenoid fossa with open physis: a case report.

BACKGROUND: Scapular fractures are uncommon injuries that account for 1% of all fractures. Ten percent of these lesions involve the glenoid fossa and intraarticular displacement is rare, not exceeding 10% of the cases. The classification of intraarticular glenoid fractures was described by Ideberg on the basis of his findings in 100 patients with this type of injury. His classification, however, does not include a dislocation of the glenoid fossa without displacement of the humeral head. METHODS: We report the case of a fracture dislocation of the glenoid fossa without displacement of the humeral head in a patient with open physis. Our surgical approach and results after 6 years of follow-up. RESULTS: Six years postoperatively the patient has minimal occasional discomfort and a full range of motion and strength, even in external rotation. Shoulder stability is also normal. Her Constant score is 97. The fracture is actually healed clinically and radiographically with no evidence of post traumatic articular degenerative disease or avascular changes. CONCLUSIONS: The fracture/dislocation of the glenoid fossa is an uncommon injury that can be effectively treated by open reduction and internal fixation. A posterior surgical approach was useful to achieve anatomic reduction and strong fixation in this case presentation.