115-肩胛骨骨折（英文）.pptVIP

Scapula Fractures Thomas P. Goss, MDRobert V. Cantu, MDUniversity of Massachusetts Medical CenterScapulothoracic Dissociation Andrew H. Schmidt, MDCreated March 2004 Outline 1. Incidence and Mechanisms 2. Diagnosis and Nonoperative Treatment 3. Fractures of the Glenoid Process 4. Isolated Fractures of the Coracoid Process Outline Continued 5. Isolated Fractures of the Acromial Process 6. Double Disruptions of the Superior Shoulder Suspensory Complex 7. Scapulothoracic Dissociation 8. Complications Incidence of Scapula Fractures 1% of all fractures 3% of injuries to shoulder girdle 5% of shoulder fractures Location of Scapula Fractures Diagnosis History typically high energy injury (80-95% incidence other injury) Mechanism often direct but can be indirect Diagnosis ultimately radiographic Radiographs “Scapula trauma series”: AP and Lat of scapula, true glenohumeral axillary view CT scanning for complex injuries with 3D reconstructions Stress AP projection if injury to the clavicular-scapular linkage suspected Nonoperative Treatment 90% scapular fractures minimally displaced Treatment in sling and swathe with gradual increase of functional use for first 6 weeks x-rays at 2 week intervals until 6 weeks Nonoperative Tx Continued At 6 weeks osseous union usually present and sling/swathe discontinued Full recovery may take 6 months to 1 year Operative Indications 1. Significantly displaced (5-10mm) fractures of glenoid cavity (rim and fossa) 2. Significantly displaced (10mm or 40 degrees rotation) fractures of the glenoid neck 3. Double Disruptions of the superior suspensory shoulder complex with displacement of one or more elements Glenoid Process Glenoid process includes glenoid cavity (rim and fossa) and glenoid neck Fractures of the Glenoid Cavity (Rim and Fossa) 10% of scapula fractures of which no more than 10% are significantly displaced Classification Glenoid Cavity Fractures Ia= anterior rim fracture Ib=posterior rim fractu