肩胛骨骨折（英文）ppt课件.ppt

Floating Shoulder Operative management recommended because of potential instability, displacement of glenoid Recent series of floating shoulders treated nonoperatively shows good results with conservative care. Nonoperative Management of Ipsilateral Fractures of the Scapula and Clavicle Retrospective review of 20 cases 11 of 20 clavicle fx’s displaced 10 mm 5 of 20 scapular fx’s displaced 5 mm Treated with sling or immobilizer Evaluated by 3 different shoulder scores, strength compared to uninjured shoulder. Edwards SG, et al. JBJS 82B: 774-80, 2000 Results 1 clavicle nonunion (segmental bone loss at injury) Strength = to opposite arm in all Constant score 96, Rowe score 95 17-18 patients excellent results depending on evaluation system Edwards SG, et al. JBJS 82B: 774-80, 2000 Summary - Floating Shoulder Nonoperative treatment sufficient for many of these injuries. Each component of the injury should be separately evaluated for indications for surgery, but the combination itself does not mandate operative intervention Scapulothoracic Dissociation Traumatic disruption of scapula from posterior chest wall Neurovascular injury common Scapulothoracic Dissociation=Closed Forequarter Amputation Scapulothoracic Dissociation Left scapulothoracic dissociation with brachial artery disruption Scapulothoracic Dissociation Rare, life-threatening injury First described in 1984 (Oreck, JBJS 66A:758). Hallmark: Severe neurovascular injury to the upper extremity, associated with lateral displacement of the scapula. Sometimes associated with obvious fracture or dislocation about the shoulder Sometimes without obvious bone injury Scapulothoracic Dissociation Caused by Blunt Trauma Review of 4 personal cases and 54 described in the literature Broad spectrum of injuries: Neurologic injuries in 94% Vascular injuries in 88% Poor Outcome Flail extremity in 52% Early amputation in 21% Death in 10%, 8% due to this injury Damschen et al, J Trauma 42:537, 1997. Musculoskeletal In