Malunion following displaced fractures of clavicle most commonly occurs with shortening and anterior rotation of the distal fragment. This results in scapular malalignment, which has been documented clinically as scapular winging. However, to our knowledge, this scapular malalignment has never been quantified radiographically. The purpose of our study was to quantify the radiographic parameters in patients with symptomatic midshaft clavicle malunions demonstrating scapular winging. Fourteen patients with symptomatic midshaft clavicle malunions demonstrating scapular winging of the affected shoulder were identified. Each patient underwent CT scanning of both clavicles and scapulae. A standardised CT protocol was used for each patient. Multiple measurements were used to document the clavicle malunion and scapular malalignment including clavicular length, the distance from the tip of the scapula to the chest wall and to the nearest adjacent spinous process, and the relative height of each scapula on the chest wall. Statistical analysis using the Student t-test was performed. The mean time from fracture was twenty-nine months. There were eleven males and three females with a mean age of 33.1 years. The mean clavicular shortening was 17mm (P> 0.001). The mean anterior-rotation through the malunion was nine degrees, and showed a trend toward significance (P=0.1). The distal fragment was anteriorly translated 13.5mm (P> 0.001) relative to the opposite normal shoulder. The scapula was displaced laterally 10.3mm (P> 0.001) from the nearest spinous process, superiorly 16.3mm and 12.2mm (P> 0.001) off the chest wall on average compared to the opposite normal shoulder. Patients with symptomatic clavicle malunions often complain of periscapular pain, and winging of the scapula has been noted in such individuals. Ours is the first study to document and quantify scapular malalignment in this clinical setting. Since most shoulder musculature is scapular based, identification and quantification of scapular malalignment may have important ramifications in decision-making regarding treatment of clavicle fractures and malunions

Scapular instability is a disabling deformity that results in pain and influences the overall upper limb function ; for which scapular stabilization may be necessary. Aim: To review the results of this procedure. Methods: 9 patients who underwent this procedure could be contacted and were assessed. We used the Disability of Arm, shoulder and Hand score(DASH) and the constant score for shoulder function including subjective assessment of patients pain and overall satisfaction and radiographs for evidence of unionwith a mean age of 36 yrs(range 21–57 yrs), performed in the period between July 1996 and October 2002 with a mean follow up period of 35.7 months,(range 10–72 months).6 of them were primary procedures and two were revisions for failed primary stabilisation . The main pre-operative complaint of these patients was dragging pain, scapular winging, painful forward flexion and abduction and sense of instability. The underlying pathology was Fascio-scapulo-humeral dystrophy in 3, sprengels shoulder in 2,brachial plexus palsy in 1, following trapezius muscle excision in 1, residual winging following shoulder fusion in 1. The technique used for fusion was plate and wires in 6, Rush pin and wires in 2. All of them had bone grafting . At the last follow up the mean DASH score was 37 and the mean constant score was 74.67. All patients had mild or no pain,felt their scapula stable and were satisfied with the outcome. The main post operative complaint was wire breakage and migration that necessitated removal in 3 patients. We conclude that scapulothoracic fusion is a valuable procedure and can restore reasonable shoulder function and relieve pain in patients with scapular instability

Study Design: Compartative cohort study. Objective: To compare the safety and efficacy of conventional posterior instrumented fusion versus thoracoscopic instrumented fusion for the surgical treatment of King Type III adolescent idiopathic scoliosis. Methods: The results of 34 consecutive patients with King type 3 scoliosis treated with one of the above techniques were analyzed independantly. Twenty-two patients underwent posterior spinal fusion (PSF) and instrumentation (Moss-Miami). Twelve patients had thoracoscopic fusion (TF) and instrumentation (Eclipse). Results: Baseline demographics (age at menarche and surgery, pre-operative Cobb angles in coronal and sagittal planes), estimated blood loss at surgery and duration of parenteral analgesia did not differ between the two groups. PSF patients had significantly higher transfusion requirements (p=0.032). Operative time (p = 0.0001), ICU stay (p = 0.005), and hospital stay (p = 0.037) were longer in TF cases. There were no complications in PSF patients. Complications in TF patients included lobar collapse (1 patient) and scapula winging (1 patient). Improvement in scoliosis among PSF patients averaged 75% (1 week), 70% (6 months), and 65% (1 year). In TF patients, mean improvement in scoliosis was 66% (1 week), 62% (6 months), and 62% (1 year). The differences between the two groups in terms of scoliosis improvement were not significant. Curves with apex at T8 or higher had better correction of scoliosis (p = 0.05). The sagittal alignment (thoracic kyphosis and lumbar lordosis) after surgery was similar between the two groups at 1 week, 6 months, and 1 year post-operatively. Conclusion: The efficacy of thoracoscopic anterior fusion and instrumentation is similar to standard posterior instrumented fusion. The advantages of the thoracoscopic technique are the avoidance of a long posterior midline scar, and lower transfusion requirement. A longer operative time, ICU and hospital stay was attributed to the steep learning curve of this endoscopic technique

Aim: To investigate the natural history and the impact of reconstruction in shoulder deformities due to obstetrical brachial plexus palsy. Methods: Pre and postoperative CT scans of bilateral upper extremities of 28 patients with obstetrical palsy were studied. The age during the preoperative CT scan ranged from 1.5 months to 10 years (average: 4 ± 3 years). 17 patients had Erbñs palsy and 11 global plexus involvement. Eighteen had primary shoulder reanimation mainly via intraplexus neurotization. Palliative surgery in 25 patients included trapezius transfer for shoulder abduction, adductors release and rerouting of the latissimus dorsi and terres major for external rotation, scapula stabilization and rotational osteotomy of the humerus. The CT measurements included: humeral head retroversion, spinoscapular angle, glenoid fossa inclination, congruence of the humeral head to the glenoid and distance of the lower angle of the scapula from the midline. Results: Preoperatively the humeral head was subluxated or dislocated posteriorly and had decreased retroversion. The hypoplastic scapula had winging and increased distance from the midline, while the glenoid fossa was more retroverted. Postoperatively all the above measurements were improved. Conclusions: Novel measurements on CT scans of bilateral shoulders provide valuable information. Surgical intervention signiþcantly improves the functional anatomy and the dynamics of the shoulder joint

Objectives

Cadaveric models of the shoulder evaluate discrete motion segments using the glenohumeral joint in isolation over a defined trajectory. The aim of this study was to design, manufacture and validate a robotic system to accurately create three-dimensional movement of the upper body and capture it using high-speed motion cameras.