Research For The Treatment Of Severe Scapular Fractures With Locking Reconstruction Plate

Objective：To discuss the status and treatment effect in scapular fractures withlocking reconstruction plate.Methods:This paper collected16cases of scapular fractures admitted indepartment orthopaedics of China-Japan union hospital of Jilin Universityfrom October2011to November2013.All the patients were treated withlocking reconstruction plates (LRP).The score of shoulder joint andimaging data before and after surgery were retrospectively studied,including11males and5females12cases on the left and4cases on theright，with the average age of41.75years(range:23-56).There were10Scapular body fractures,5scapular neck fractures,2glenoid cavity(rear) fractures and1shoulder blade fractures. All patients,15caseshave different degree of compound injury, and actively deal withcombined injury before open reduction and fixation with LRP in1to3weeks. according to individual condition, giving the postoperatives corresponding functional rehabilitation exercises under guidance ofphysicians. Before operation，giving the shoulder a high quality digitalsubtraction angiography (DSA) X ray film, a CT scan and3Dreconstruction, using HSS and UCLA scoring system to evaluate shoulderjoint function. All patients had a bed X ray film at the shoulder in1-2daysand repeated it after1month,3months,6months and1year，CT reviewwhen necessary. All cases were followed from4to25months，throughphysical examination and X ray film we judged fracture healing，gaveshoulder joint function score, recorded complications and correspondingoutcome. Preoperative and postoperative groups of data were used forstatistical analysis with SPSS20.0software.Results:All cases were followed after operation, from4to25months. Themajority of patients were inspected after1,3,6,12months andfollowed by telephone; A small number failed to do it, only given atelephone. Among them，1case was not of rehabilitation exercise inaccordance with the requirements of postoperative assessment, had apoor shoulder function；1case with fat liquefaction of incision andpostoperative pain get better3weeks later by having painkillers andanti-inflammatory drugs （cephalosporin），and was changed incisiondressing frequently.2patients of shoulder pain after activities， haveoral pain medicine when pain and continue to proceed rehabilitation exercise. The remaining cases had good results. Almost patients’shoulder pain disappeared basically after operations, shoulder activitymarkedly improved, to meet the needs of the daily life and work. The HSSscore and activity of preoperative and postoperative shoulder joint wereincreased significantly, P <0.05, with statistical significance.Conclusion:1. The LRP can be reconstructived according to the anatomicalstructures of the shoulder blade shape, suitable for internal fixationof the shoulder neck, shoulder body, shoulder? and so on.2. With firm LRP fixation, the postoperatives can be early ofrehabilitation and function exercises.3. The curative effect of LRP in the treatment of glenoid cavity trailingedge, shoulder neck and shoulder body with fractures is distinct.