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.
SourceAvailable from: W Angus Wallace[Show abstract] [Hide abstract]
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). DOI:10.1111/j.1758-5740.2010.00103.x
[Show abstract] [Hide abstract]
ABSTRACT: Scapulothoracic fusion (STF) may be an option to alleviate pain and restore function. The purpose of this study is to report the clinical outcome of patients who underwent STF for the treatment of painful scapular winging. From 1999 through 2008, 10 patients (12 shoulders) underwent an STF for painful winging of the scapula. The mean follow-up period was 41 months (range, 8-72 months). Indications for STF included winging in association with excessive medial and/or lateral clavicular resection and facioscapulohumeral dystrophy, as well as scapular winging related to combined long thoracic and spinal accessory nerve palsy. A retrospective review was performed to evaluate the subjective shoulder value, visual analog scale score, range of motion, unions, and complications. There was a statistically significant improvement in the subjective shoulder value, visual analog scale score, range of motion, and satisfaction postoperatively. The overall complication rate was 50% (6 of 12). There were 2 persistent nonunions (2 of 12, 17%), and 50% (6 of 12) of all fusions required subsequent hardware removal because of discomfort. Complications included pleural effusion (3 of 12, 25%), hemopneumothorax (1 of 12, 8%) pulmonary embolus (1 of 12, 8%), and infection (1 of 12, 8%). With the exception of the revision nonunion, all complications resolved with no negative sequelae. STF results in improved function and pain relief. STF is associated with a high short-term complication rate with limited long-term sequelae.Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 11/2013; DOI:10.1016/j.jse.2013.08.009 · 2.37 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: OBJETIVO: Avaliar a técnica cirúrgica da artrodese escapulotorácica na distrofia fascioescapulumeral (DFEU), analisando os resultados e as complicações pós-operatórias. MÉTODOS: No período de fevereiro de 1992 a fevereiro de 2006 foram realizadas oito artrodeses escapulotorácicas em cinco pacientes no Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo (DOT-FCM-SCSP). Os critérios para indicação cirúrgica foram: dor, déficit funcional do membro acometido, fadiga muscular e deformidade estética. Na técnica cirúrgica empregada para a artrodese foi realizada a fixação da escápula à parede torácica por meio de amarrilho com fios de poliéster nº 5, uma placa metálica estreita e fina, além de colocação de enxerto esponjoso autólogo. RESULTADOS: O seguimento médio dos pacientes foi de 124 meses. Na comparação da amplitude de movimentos pré e pós-operatórios, notou-se melhora na elevação, mantida a rotação lateral, com o UCLA no período pré-operatório variando de 7 a 11 e pós-operatório de 29 a 33. Dentre as complicações, encontraram-se dois casos de pneumotórax, um caso de soltura do material de síntese e um caso de ausência de consolidação óssea. COMENTÁRIO: Obtida consolidação da artrodese em seis casos, além da melhora da dor e elevação. Dois casos foram reoperados, sendo um devido à quebra do material e o outro, à não consolidação. Todos evoluíram para consolidação.Revista Brasileira de Ortopedia 02/2008; 43(1-2):41-47.