Scapulothoracic Arthrodesis in Facioscapulohumeral Muscular Dystrophy
Department of Orthopedic and Trauma Surgery, Pitié-Salpêtrière Teaching Hospital, Pierre and Marie Curie University, Paris, France. Clinical Orthopaedics and Related Research
(Impact Factor: 2.77).
05/2003; 409(409):106-13. DOI: 10.1097/01.blo.0000057790.10364.35
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: Tests were carried out on the strength of six different suture techniques used to join polyester lace ends, for example, in interscapulo-scapulocostal scapulopexy. The following sutures were used: four 5-cm rows of a continuous suture, four 2.5-cm rows of a continuous suture, two 5-cm rows of a continuous suture, 4 or 8 interrupted sutures, and 4 U-sutures. The laces were tested in tension, and load and elongation recorded. The strongest techniques involved a suture of four 5-cm rows of continuous thread (average maximum load at point of failure 1484 N). This was higher than the maximum load at failure of the point of attachment to the scapula.
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ABSTRACT: Winging of the scapula is one of the major features of the rare facio-scapulo-humeral muscular dystrophy. Several methods of retention and fixation of the scapulae have been published, but most have technical disadvantages or complications. A modified method of operative fixation of the scapula to the chest using three polyester laces is described with the results of cadaveric studies on the stability of this system. In order to determine the optimal region for the scapula fixation using polyester laces we performed pull-out tests on twenty cadaver scapulae. Four points of insertion in the inferior part of the scapula were tested. The lateral margin showed the best results with regard to the tensile strength and the morphology of the resulting fractures. The elongation of the laces was measured as well. Compared to scapulothoracic arthrodesis interscapulo-scapulocostal scapulopexy leads to greater preserved mobility between the scapula and the chest wall and conserves vital capacity.
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