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Scapula: fracture repair

ISSN 2398-2977

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Introduction

  • Supraglenoid tubercle and transverse fractures of the neck and body of the scapula can be treated by surgical methods in selected cases.

Uses

Advantages

  • Fragment resection:
    • Eliminates pain associated with movement at fracture site.
    • Reduce risk of osteoarthritis due to joint incongruity.
    • Fibrous reattachment of biceps brachii tendon may occur following removal of supraglenoid tubercle fragment, restoring tendon's role in shoulder extension.
  • Fracture reduction and internal fixation:
    • Realignment of articular surface.
    • Partial or complete tenotomy of biceps brachii tendon reduces post-operative tension on the fracture site.

Disadvantages

  • Same as scapula: fractures   Scapula: fracture  .
  • Resection of tubercle: disruption of joint surfaces with loss of part of glenoid cavity.
  • Internal fixation:
    • Strong distractive forces by biceps muscle may decrease stability of repair.
    • Large animals (>400 kg) are not good candidates.
    • Poor screw-holding ability of scapula.
    • Difficult to achieve good anatomic reduction.

Alternative techniques

  • Resection of fracture fragment.
  • Conservative management.
  • See scapula: fractures   Scapula: fracture  .

Time required

Preparation

  • General anesthesia induction and maintenance: 20 min.
  • Aseptic preparation: 10-15 min.

Procedure

  • Resection of tubercle: 45-75 min.
  • Internal fixation: 60-120 min.

Decision taking

Criteria for choosing test

  • Duration and severity of fracture, especially involvement of articular surface and atrophy of shoulder muscles.

Requirements

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Preparation

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Technique

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Dart A J et al (1992) Repair of a supraglenoid tuberosity fracture in a horse. JAVMA 201 (1), 95-96 PubMed.
  • Bukowiecki C F et al (1989) Internal fixation of comminuted transverse scapular fracture in a foal. JAVMA 195 (6), 781-783 PubMed.
  • Shamis L D et al (1989) Internal fixation of a transverse scapular neck fracture in a filly. JAVMA 195 (10), 1391-1392 PubMed.
  • Schneider J E et al (1985) Scapular notch resection for suprascapular nerve decompression in 12 horses. JAVMA 187 (10), 1019-1020 PubMed.
  • McIlwraith C W (1983) Surgery of the hock, stifle and shoulder. Vet Clin North Am Large Anim Pract 5 (2), 333-362 PubMed.

Other sources of information

  • Adams S B (1996) Fractures of the scapula. In: Equine Fracture Repair. Ed: A J Nixon. W B Saunders, USA. ISBN 0-7216-6754-6.