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).

[Surgical treatment of acromioclavicular dislocation: Tension band wiring versus hook plate]. / Chirurgická lécba akromioklavikulární luxace: Tahová cerkláz versus hákovitá dlaha.

INTRODUCTION: The aim of the prospective randomized study was to compare tension wire cerclage and hook plate in the treatment of AC dislocation, primarily from the viewpoint of functional and radiological results. METHOD: The cohort comprised 80 patients with acute acromioclavicular (AC) dislocation of types 3, 4 and 5 of Rockwood classification. The diagnosis was based on the clinical (disfiguration and instability) and radiographic examination (AP and stress radiograph). Forty patients were treated with tension band wiring (TBW) and another 40 with a hook plate (HP). Evaluation was performed during one year after the surgery based on radiographs and the Constant score. RESULTS: The mean Constant score 3 months after the surgery was 84 points for TBW and 88 points for HP. One year after the surgery, the result was the same in both groups: 93 points. In HP group the score increased from 56 to 78 points between 2 and 4 weeks from the surgery. In 71 cases the postoperative position of the AC joint and implant was assessed as correct. Malposition of Kirschner wires was recorded in 6 cases and horizontal widening of the AC joint in 3 cases. Redislocation of up to 50100% of the width of acromion was shown by radiograph in 4 TBW patients (10%) and in 5 HP patients (13%). A visible osteolysis of the distal surface of acromion was found in 83% of patients with HP. Complications were recorded in 30% of TBW patients and in 5% of HP patients. CONCLUSION: Based on radiological and clinical results assessed 3 months and 1 year after the surger, the hook plate and tension band wiring are comparable treatment methods for AC dislocation. The hook plate is associated with a lower complication rate and allows earlier full weight bearing and mobility than tension wire cerclage. In TBW we recommend to remove the implant after 8 weeks; 6 weeks are in our view too short a period for the healing of soft tissues. In HP it is suitable to remove the hardware by 3 months due to potential subacromial irritation and pressure-induced osteolysis.

[Trochanteric fractures - general overview]. / Trochanterické zlomeniny - základní prehled.

The current possibilities concerning selection of implants and the respective devices provide us with good prerequisites for a successful treatment of almost all trochanteric fractures. The basis is a proper evaluation of the type of the fracture and respecting its biomechanical features. Based on this analysis we select the implant and the proper operative technique. Quality is the highest priority as concerns the actual operation. A number of patients tolerate only one operation and it is better if it takes 10 minutes more than if it is performed improperly. The so called implant failure is in most cases the surgeones failure.

[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.