OBJECTIVE: To explore effectiveness of TiRobot-assisted screw implantation in the treatment of coracoid process fractures of the scapula. METHODS: A retrospective analysis was conducted on the clinical data from 24 patients with coracoid process fractures of the scapula admitted between September 2019 and January 2024 and met selection criteria. Among them, 12 patients underwent TiRobot-assisted screw implantation (robot group) and 12 underwent manual screw implantation (control group) during internal fixation. There was no significant difference ( P>0.05) in baseline data such as gender, age, body mass index, disease duration, cause of injury, coracoid process fracture classification, and proportion of patients with associated injuries between the two groups. The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, coracoid process fracture healing time, and complications were recorded and compared, as well as pain visual analogue scale (VAS) score, and Constant-Murley score at last follow-up. RESULTS: The intraoperative blood loss and incision length in the robot group were significantly lower than those in the control group ( P<0.05); however, there was no significant difference in operation time and hospital stay between the two groups ( P>0.05). All patients were followed up 8-27 months (mean, 17.5 months), and the difference in follow-up time between the two groups was not significant ( P>0.05). At last follow-up, the VAS score for shoulder pain in the robot group was signifncatly lower compared to the control group, and the Constant-Murley score was significantly higher ( P<0.05). In the robot group, 16 screws were implanted intraoperatively, while 13 screws were implanted in the control group. Radiographic re-evaluation showed that the excellent and good rate of screw implantation was higher in the robot group (93.8%, 15/16) than in the control group (61.5%, 8/13), but the difference in the precision of screw implantation between the two groups was not significant ( P>0.05). Four patients in the robot group and 1 in the control group achieved double screws fixation; however, the difference in achieving double screws fixation between the two groups was not significant ( P>0.05). All fractures healed in both groups with 1 case of malunion in the control group. There was no significant difference in healing time between the two groups ( P>0.05). During follow-up, 1 patient in the control group experienced screw loosening and displacement. There was no significant difference in the incidence of screw loosening and fracture malunion between the two groups ( P>0.05). CONCLUSION Compared with manual screw implantation, TiRobot-assisted minimally invasive treatment of coracoid process fractures of the scapula can reduce intraoperative blood loss, shorten incision length, alleviate pain, and obtain better promote shoulder joint functional recovery.
Humans ; Male ; Female ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Minimally Invasive Surgical Procedures/instrumentation* ; Adult ; Middle Aged ; Fractures, Bone/surgery* ; Bone Screws ; Coracoid Process/surgery* ; Robotic Surgical Procedures/methods* ; Scapula/surgery* ; Treatment Outcome ; Operative Time ; Young Adult ; Length of Stay ; Blood Loss, Surgical

OBJECTIVE: To compare the effectiveness of posterior axillary edge approach and arthroscopic assisted reduction in the treatment of Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula. METHODS: The clinical data of 26 patients with fresh Ideberg type Ⅰ and Ⅱ scapular fractures admitted between June 2021 and September 2024 who met the selection criteria were analyzed retrospectively. The patients were divided into two groups according to different treatment methods. Ten cases in the posterior axillary edge group were fixed by open reduction plate through the posterior axillary edge approach, and 16 cases in the arthroscopy group were treated with suture anchor fixation under arthroscopy. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, surgical side, Ideberg type, cause of injury, time from injury to operation, rotator cuff injury, and superior labrum anterior posterior (SLAP) injury, etc. The operation time and fracture healing time were recorded and compared between the two groups, and the shoulder pain was evaluated by visual analogue scale (VAS) score at 1 week, 1 month, and 3 months after operation. At 3 and 6 months after operation, the range of motion of shoulder joint in anteflexion, abduction, external rotation, internal rotation, and backward extension was evaluated, the upper limb dysfunction was evaluated by the Disability Assessment Scale of Arm, Shoulder, and Hand (DASH), and the shoulder joint function was evaluated by the Constant-Murley score. The differences between 6 months and 3 months after operation (changes) were statistically analyzed. RESULTS: Patients in both groups were followed up 11-13 months, with an average of 12.5 months. The operation time and fracture healing time in the posterior axillary edge group were significantly shorter than those in the arthroscopy group ( P<0.05). There was no complication such as wound infection, vascular and nerve injury, loss of reduction, bone nonunion, or glenohumeral instability in both groups. At 1 week after operation, the VAS score in the posterior axillary edge group was significantly higher than that in the arthroscopy group ( P<0.05); there was no significant difference in the VAS score between the two groups at 1 and 3 months after operation ( P>0.05). At 6 months after operation, the changes of shoulder joint in anteflexion, internal rotation range of motion and DASH scores in the posterior axillary edge group were significantly lower than those in the arthroscopy group ( P<0.05), while the changes of abduction, external rotation, backward extension range of motion and Constant-Murley scores were not significantly different between the two groups ( P>0.05). CONCLUSION For Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula, the posterior axillary edge approach for internal fixation has a short operation time, fast fracture healing, and is beneficial for early functional recovery; arthroscopic assisted reduction has minimal trauma and can handle joint injuries simultaneously. Both surgical procedures are safe and effective, and individualized selection should be made based on soft tissue conditions and combined injuries.
Humans ; Arthroscopy/methods* ; Scapula/surgery* ; Male ; Female ; Retrospective Studies ; Adult ; Fracture Fixation, Internal/instrumentation* ; Fractures, Bone/surgery* ; Middle Aged ; Treatment Outcome ; Bone Plates ; Suture Anchors ; Fracture Healing ; Range of Motion, Articular ; Young Adult ; Shoulder Joint/surgery* ; Operative Time

OBJECTIVE: To compare clinical effect of arthroscopic double row fixation and single row fixation in treating Ideberg typeⅠA scapular glenoid fracture. METHODS: From June 2018 to December 2022, 26 patients with Ideberg typeⅠA scapular glenoid fracture treated with shoulder arthroscopy were divided into single-row anchor group and double-row anchor group according to the fixation method of fracture block. There were 12 patients in single-row anchor group, including 7 males and 5 females, aged from 25 to 53 years old with an average of (38.42±9.61) years old;the time from injury to operation ranged from 2 to 7 days with an average of (4.75±1.82) days. There were 14 patients in double-row anchor group, including 10 males and 4 females, aged from 21to 53 years old with an average of (37.36±10.19) years old;the time from injury to operation ranged from 1 to 8 days with an average of (4.21±2.01) days. The changes of shoulder joint flexion, abduction, lateral lateral rotation, Constant-Murley shoulder function score and Rowe scores were compared between two groups before operation and 1 year after operation. The percentage of bone mass in pelvis area before operation and the percentage of bone defect in pelvis area at the latest follow-up were compared between two groups. RESULTS: All patients were followed up for 12 to 15 months with an average of (13.08±1.17) months in single-row anchor group and 12 to 15 months with an average of (13.29±1.07) months in double-row anchor group, with no statistical significance between two groups (P>0.05). The results of anterior flexion, abduction and lateral lateral rotation in single-row anchor group were(86.67±6.62) °, (79.50±5.68) °, (38.17±1.70) ° before operation, and (162.50±4.52)°, (169.17±3.35)°, (50.67±10.20)° at 1 year after operation; while in double-row anchor group were (84.14±5.48) °, (81.71±5.20) °, (39.29±3.63) ° before operation and (162.29 ± 5.53) °, (167.14±3.61) °, (56.93±9.56) ° at 1 year after operation;the difference between two groups before operation and 1 year after operation was statistically significant (P<0.05). There were no significant difference between two groups (P>0.05). Constant-Murley scores and Rowe scores in single-row anchor group were (55.42±3.75), (43.75±18.49) before operation and (94.83±2.21), (95.42±4.50) at 1 year after operation, respectively;while in double-row anchor group were (54.50±7.88), (41.79±18.25) before operation and (94.36±4.73), (95.00±4.80) at 1 year after operation;there was no significant difference in Constant-Murley score and Rowe score between two groups before operation and 1 year after operation (P>0.05). There was significant difference in the percentage of bone mass in pelvis area between two groups before operation (P>0.05). There was no significant difference in the percentage of bone defect in the shoulder area between single-row anchor group(4.42±1.51)% and double-row anchor group (2.71±1.44)% at 1 year after operation (P<0.05). CONCLUSION Both single and double row fixation techniques for the treatment of Ideberg typeⅠA scapular glenoid fracture could receive satisfactory functional recovery. However, double-row fixation has more advantages in reducing bone resorption of fracture mass.
Humans ; Female ; Male ; Middle Aged ; Arthroscopy/methods* ; Adult ; Scapula/surgery* ; Case-Control Studies ; Fractures, Bone/physiopathology* ; Fracture Fixation, Internal/methods* ; Shoulder Joint/physiopathology* ; Range of Motion, Articular

OBJECTIVE: To compare clinical efficacy of transaxillary posterior margin approach and translateral margin approach for the treatment of Miller typeⅡand Ⅳ scapular fractures. METHODS: From June 2020 to June 2024, 28 patients with fresh scapular fractures (Miller typeⅡand Ⅳ) who were treated with open reduction and locked plate internal fixation were retrospectively analyzed and divided into two groups. There were 13 patients in posterior axillary margin group, including 8 males and 5 females, aged from 26 to 71 years old with an average of (39.2±6.5) years old;5 patients with typeⅡand 8 patients with type Ⅳ according to Miller classification;9 patients caused by falling down, 4 patients caused by car accident;7 patients on the right side, 6 patients on the left side;the time from injury to operation ranged from 3 to 5 days with an average of (4.07±0.86) days. There were 15 patients in lateral scapula margin group, including 10 males and 5 females, aged from 27 to 63 years old with an average of (43.6±8.5) years old;7 patients with typeⅡand 8 patients with type Ⅳ according to Miller classification;10 patients caused by falling down, 5 patients caused by car accident;6 patients on the right side, 9 patients on the left side;the time from injury to operation ranged from 3 to 5 days with an average of (4.20±0.67) days. Operative time, intraoperative blood loss, fracture healing time, glenopolar angle (GPA) immediately after operation were compared between two groups. Visual analogue scale (VAS) and Constant-Murley shoulder joint function score were used to evaluate clinical effect at 3 and 6 months after operation, respectively, and the joint motions were evaluated at 6 months after operation. RESULTS: None of patients occurred wound infection, vascular and nerve damage, loosening or rupture of internal fixation. Both groups were followed up for 8 to 12 months with an average of (9.6±1.5) months. Operative time and intraoperative blood loss of posterior axillary margin group were (76.92±5.60) min and (84.86±10.08) ml, respectively, which were better than those of lateral scapula margin group(84.67±6.93) min and(115.00±12.39) ml(P<0.05). Immediate GPA in posterior axillary margin group (36.62±0.87) °and lateral scapula margin group (36.20±0.82)°were significantly improved compared with preoperative (16.10±1.14) °, (16.20±1.20) °(P<0.05), while there was no statistical significance between two groups (P>0.05). There were no significant difference in fracture healing time and postoperative VAS at 3 and 6 months between two groups (P>0.05). Postoperative Constant-Murley score of posterior axillary margin group (75.00±4.02) was higher than that of lateral scapular margin group (70.86±4.24) at 3 months (P<0.05), while there was no significant difference between two groups at 6 months after operation (P>0.05). At 6 months after operation, joint motion of posterior axillary margin group in flexion (160.38±13.61)°, abduction (154.61±13.91)°, rotation (83.08±2.53)°, rotation (62.69±2.59) ° and extension (51.54±3.15) °, respectively, which were higher than that of lateral scapular margin group in (148.00±15.44)°, (144.00±11.05)°, (79.67±3.99)°, (57.33±4.95)°, (47.33±4.16)°(P<0.05). CONCLUSION Compared with lateral margin of scapula intermuscular space approach, Buttress approach through the posterior axillary margin for the treatment of Miller typeⅡand Ⅳ scapular fractures provides extensive intraoperative visual field exposure, stable fracture support and less surgical trauma, which could shorten operative time and reduce intraoperative blood loss, providing a new reference for the treatment of complex scapular fractures.
Humans ; Male ; Female ; Middle Aged ; Scapula/surgery* ; Adult ; Aged ; Fractures, Bone/physiopathology* ; Fracture Fixation, Internal/methods* ; Retrospective Studies ; Axilla/surgery*

OBJECTIVE: To establish digital model of Ideberg typeⅡregional glenoid fracture anatomical plate with 3D metal printing technology. METHODS: The scapular imaging data of a 34-year-old healthy male volunteer were retrospectively selected. Mimics 15.01, NX 12.0 and other software were used to design Ideberg typeⅡ regional scapular fracture guide plate system. STL data were input into a metal 3D printer to print 1∶1 scapular model and anatomical plate of scapular pelvis with guide sleeve. The fit of the plate was tested in vitro and the accuracy of the screw position was evaluated by imaging. The printing time of scapular model, design of the nail path and making time of the anatomic guided plate were recorded. RESULTS: 3D metal-printed Ideberg typeⅡ guide plate for scapular fracture fitted well to 3D printed scapular model, the locking screw was oriented accurately, and X-ray and CT showed good screw position. The printing time of scapula model, time of nail path design and special-shaped anatomical guide plate production were 52.0, 15.0 and 320 min, respectively. CONCLUSION Anatomical plates based on 3D metal printing technology could achieve good adhesion of Ideberg typeⅡ regional fractures and precise screw placement, providing a new and accurate surgical method for the treatment of Ideberg typeⅡ glenoid fractures.
Humans ; Printing, Three-Dimensional ; Male ; Adult ; Bone Plates ; Fractures, Bone/diagnostic imaging* ; Fracture Fixation, Internal/methods* ; Pelvic Bones/surgery* ; Metals ; Scapula/surgery* ; Models, Anatomic

OBJECTIVE: To investigate the effect of glenohumeral bone structure on anterior shoulder instability by three-dimensional CT reconstruction. METHODS: The clinical data of 48 patients with unilateral anterior shoulder dislocation (instability group) and 46 patients without shoulder joint disease (control group) admitted between February 2012 and January 2024 were retrospectively analyzed. There was no significant difference in gender and side between the two groups ( P>0.05). The patients were significantly younger in the instability group than in the control group ( P<0.05). The glenoid joint morphological parameters such as glenoid height, glenoid width, ratio of glenoid height to width, glenoid inclination, the humeral containing angle, and glenoid version were measured on three-dimensional CT reconstruction of the glenoid. The differences of the above indexes between the two groups were compared, and the differences of the above indexes between the two groups were compared respectively in the male and the female. Random forest model was used to analyze the influencing factors of anterior shoulder instability. RESULTS: The comparison between the two groups and the comparison between the two groups in the male and the female showed that the ratio of of the instability group glenoid height to width was larger than that of the control group, the glenoid width and humeral containing angle were smaller than those of the control group, and the differences were significant ( P<0.05); there was no significant difference in glenoid height, glenoid inclination, and glenoid version between the two groups ( P>0.05). The accuracy of the random forest model was 0.84. The results showed that the top four influencing factors of anterior shoulder instability were ratio of glenoid height to width, the humeral containing angle, age, and glenoid width. CONCLUSION Ratio of glenoid height to width and the humeral containing angle are important influencing factors of anterior shoulder instability.
Humans ; Joint Instability/diagnostic imaging* ; Male ; Female ; Shoulder Joint/diagnostic imaging* ; Shoulder Dislocation/diagnostic imaging* ; Retrospective Studies ; Tomography, X-Ray Computed ; Adult ; Imaging, Three-Dimensional ; Young Adult ; Middle Aged ; Adolescent ; Glenoid Cavity/pathology*

OBJECTIVE: To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations. METHODS: Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index. RESULTS: Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R ²=0.084. CONCLUSION Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.
Female ; Male ; Humans ; Adult ; Shoulder Joint/diagnostic imaging* ; Shoulder Dislocation/diagnostic imaging* ; Joint Dislocations ; Scapula/diagnostic imaging* ; Thorax

OBJECTIVE: To analyze the effect of lag screw and support plate through axillary approach for the treatment of Ideberg typeⅡscapular pelvis fracture. METHODS: From January 2016 to June 2021, 26 patients with Ideberg typeⅡglenoid fractures were treated with trans-axillary lag screw combined with supporting plate, including 15 males and 11 females. The age ranged from 21 to 75 years, with an average of (43.12±6.56) years old. The Constant-Murley Shoulder joint Scale and University of California at Los Angeles (UCLA) score were used to evaluate the function and clinical efficacy of shoulder joint. RESULTS: All patients were followed up, and the duration ranged from 19 to 42 months, with an average of (30.6±10.5) months. One year after surgery, the Constant-Murley score increased from preoperative 34.9±2.5(ranged, from 28 to 47) to 87.2±6.8(ranged, from 70 to 95). The UCLA score improved from preoperative 17.9±1.7(9 to 25) to 33.1±2.3(29 to 35). Seventeen patients got an excellent result, with 7 good, and 2 fair. None of the patients had infection, screw, and plate loosening, fracture, and other complications after surgery. Two patients had different degrees of Chronic pain in the shoulder during the follow-up period. CONCLUSION The treatment of Ideberg typeⅡscapular glenoid fractures through axillary approach with lag screws and supporting steel plates has the advantages of convenient exposure, direct visual restoration of the normal anatomical shape of the scapular glenoid, selection of suitable positions for screw and steel plate placement, achieving better treatment results, and fewer complications. It is an effective and reliable surgical method.
Female ; Male ; Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Scapula ; Bone Plates ; Bone Screws ; Fractures, Bone ; Steel ; Pelvis

OBJECTIVE: To investigate the efficacy of posterior axillary approach internal fixation for Ideberg Ⅰa andⅡ glenoid fractures. METHODS: From December 2018 to September 2021, 9 patients with lower part of glenoid fractures were treated by posterior axillary approach, including 3 males and 6 females, aged from 50 to 78 years old. All the fractures were closed fractures. According to Ideberg type of scapular glenoid fracture was type Ⅰa in 6 cases and type Ⅱ in 3 cases. AP and lateral X-ray films of scapula were taken at 6, 12 weeks and 6 and 12 months postoperatively. Constant-Murley and disabilities of the arm shoulder and hand (DASH), and other complications were recorded at the latest follow-up. RESULTS: Nine patients were followed up, ranged from 6 to 15 months. And bone healing was achieved in all 9 patients at the final follow-up, the healing time 3 to 6 months, Constant-Murley score at the final follow-up ranged from 55 to 96, and DASH score ranged from 3.33 to 33.33. Both of them were better than preoperative. CONCLUSION The posterior axillary approach internal fixation for Ideberg Ⅰa and Ideberg Ⅱ Glenoid fractures scapular fracture is satisfactory and worthy of clinical application.
Male ; Female ; Humans ; Middle Aged ; Aged ; Fractures, Bone/surgery* ; Fracture Fixation, Internal ; Shoulder/surgery* ; Scapula/surgery* ; Shoulder Fractures ; Fractures, Closed ; Treatment Outcome ; Retrospective Studies

The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.
Humans ; Shoulder Joint/surgery* ; Shoulder Dislocation/surgery* ; Shoulder ; Joint Instability/surgery* ; Scapula ; Joint Dislocations ; Recurrence ; Arthroscopy/methods*