Scapulothoracic arthrodesis in facioscapulohumeral muscular dystrophy.
ABSTRACT Forty-nine scapulothoracic arthrodeses were done in 33 patients with facioscapulohumeral muscular dystrophy to improve upper limb performance during activities of daily living. Mean followup was 102 months (range, 12-257 months). An initial average increase in shoulder abduction of 25 degrees and forward elevation of 29 degrees was seen. Complications included pleural effusion in four patients, atelectasis in one patient, stress fractures in both scapulas in one patient, asymptomatic fractures of the two lower wired ribs in one patient, and spontaneously reversible neurologic complications in two patients. No effect on respiratory function was seen.
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ABSTRACT: Patients with facioscapulohumeral dystrophy (FSHD) are affected mostly by impaired shoulder function. Scapulothoracic arthrodesis was introduced to improve shoulder function. We evaluated the outcomes of scapulothoracic arthrodesis using multifilament cables, performed on 13 patients with FSHD (18 shoulders). There were eight males and five females (mean age, 29 years; range, 20-50 years). Outcome criteria were active shoulder forward flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, respiratory function tests, and a new shoulder function score. Patients were followed for a minimum of 24 months (average, 35.5 months; range, 24-87 months). Solid fusion was obtained in all shoulders (two after revision); active abduction range increased from 47.2 degrees +/- 11.6 degrees to 102.2 degrees +/- 10.0 degrees (mean +/- standard deviation) and anterior flexion range from 55.6 degrees +/- 16.1 degrees to 126.1 degrees +/- 20.9 degrees . The DASH score decreased from 33.6 +/- 8.9 points preoperatively to 11.6 +/- 8.0 points postoperatively. Shoulder function score increased from 15.9 +/- 2.4 points to 22.2 +/- 1.3 points. Scapulothoracic arthrodesis provides satisfactory function in patients with FSHD. Our data suggest use of multifilament cables for fixation is a reasonable option with an acceptable complication rate. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 04/2009; 467(8):2090-7. · 2.79 Impact Factor
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ABSTRACT: Scapulothoracic fusion (STF) for painful winging of the scapula in neuromuscular disorders can provide effective pain relief and functional improvement, but there is little information comparing outcomes between patients with dystrophic and non-dystrophic conditions. We performed a retrospective review of 42 STFs in 34 patients with dystrophic and non-dystrophic conditions using a multifilament trans-scapular, subcostal cable technique supported by a dorsal one-third semi-tubular plate. There were 16 males and 18 females with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0 years (2.0 to 10.6). The mean Oxford shoulder score improved from 20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions had lower overall functional scores but achieved greater improvements following STF. The mean active forward elevation increased from 59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10° to 90°) to 83° (30° to 130°) with a greater range of movement achieved in the dystrophic group. Revision fusion for nonunion was undertaken in five patients at a mean time of 17 months (7 to 31) and two required revision for fracture. There were three pneumothoraces, two rib fractures, three pleural effusions and six nonunions. The main risk factors for nonunion were smoking, age and previous shoulder girdle surgery. STF is a salvage procedure that can provide good patient satisfaction in 82% of patients with both dystrophic and non-dystrophic pathologies, but there was a relatively high failure rate (26%) when poor outcomes were analysed. Overall function was better in patients with dystrophic conditions which correlated with better range of movement; however, patients with non-dystrophic conditions achieved greater functional improvement.Journal of Bone and Joint Surgery - British Volume 09/2012; 94(9):1253-9. · 2.69 Impact Factor
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ABSTRACT: Background Scapulothoracic (ST) fusion has been recommended for suitable patients suffering from FacioScapuloHumeral Dystrophy (FSHD). It helps in creating a fulcrum for the deltoid and prevents winging of the scapula during flexion and abduction of the arm, thus improving activities of daily living. We present here an overview of the techniques used and the results of 9 ST fusion carried out at our department.Method The scapula is fixed to the underlying rips using Luque wires around the 2nd to 6th ribs, then passed through the medial border of the scapula, then through an 8 hole semi tubular plate placed over the dorsal aspect of the whole medial border of the scapula. After which the Luque wires are tied firmly, locking the scapula onto the chest wall. Morsellised bone allograft is placed between the scapula and the ribs before tightening the wires.Results In total 9 ST fusions were carried out. No Intra-operative complications occurred but 2 patients developed haemothoraces post-operatively, one resolved with chest drain and one needed thoracotomy. Late complications included one scapula fracture (subsequently internally fixed), one frozen shoulder (resolved with physiotherapy) and one protruding plate (subsequently removed). An average of 40 degrees of additional abduction was achieved and overall good patients satisfaction.Shoulder & Elbow 01/2011; 3(1).