Aims

The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula.

Aims. The present study aimed to investigate the long-term functional results of scapulothoracic fusion using multifilament cables in patients with facioscapulohumeral dystrophy (FSHD) to identify if the early improvement from this intervention is maintained. Patients and Methods. We retrospectively investigated the long-term outcomes of 13 patients with FSHD (18 shoulders) in whom scapulothoracic fusion using multifilament cables was performed between 2004 and 2007. These patients have previously been reported at a mean of 35.5 months (24 to 87). There were eight men and five women with a mean age of 26 years. Their mean length of follow-up of our current study was 128 months (94 to 185). To evaluate long-term functional results, the range of shoulder flexion and abduction, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with a comparison of preoperatively, interim and at the final outcomes. The fusion was examined radiographically in all. Results. The complication rate was 33% (six of 18 scapulothoracic fusions) in 13 patients, which comprised failure of fusion in four shoulders (four patients) all occurring within the first year postoperatively. In two shoulders (one patient) wound problems arose due to attribution from the cables which required shortening but the fusion developed satisfactorily. At the final examination, the mean QuickDASH score and range of movement significantly improved in all but one patient (p < 0.001, p < 0.001 and p < 0.001). In the comparison of 13 patients’ mid- and long-term results, the mean QuickDASH score decreased from 9.8 (. sd. 6.7; 3 to 26) in the third year to 9.1 (. sd. 5.6; 3 to 22) in the tenth year (p = 0.7); the mean range of shoulder flexion and abduction decreased from 129° (. sd. 22°; 90° to 160°) and 124° (. sd. 12; 100° to 150°) at the mid-term to 103° (. sd. 12°; 80° to 120°) and 101° (. sd. 8°; 80° to 120°) at the long-term, respectively (p = 0.78 and p = 0.65). Conclusion. Scapulothoracic fusion using a multiple cabling method can confer a considerable improvement in clinical and functional outcomes for most patients with FSHD after a long follow-up period. The technique requires careful execution to avoid complications. Cite this article: Bone Joint J 2018;100-B:953–6

Scapulothoracic fusion (STF) for painful winging of the scapula in neuromuscular disorders can provide effective pain relief and functional improvement, but there is little information comparing outcomes between patients with dystrophic and non-dystrophic conditions. We performed a retrospective review of 42 STFs in 34 patients with dystrophic and non-dystrophic conditions using a multifilament trans-scapular, subcostal cable technique supported by a dorsal one-third semi-tubular plate. There were 16 males and 18 females with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0 years (2.0 to 10.6). The mean Oxford shoulder score improved from 20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions had lower overall functional scores but achieved greater improvements following STF. The mean active forward elevation increased from 59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10° to 90°) to 83° (30° to 130°) with a greater range of movement achieved in the dystrophic group. Revision fusion for nonunion was undertaken in five patients at a mean time of 17 months (7 to 31) and two required revision for fracture. There were three pneumothoraces, two rib fractures, three pleural effusions and six nonunions. The main risk factors for nonunion were smoking, age and previous shoulder girdle surgery. STF is a salvage procedure that can provide good patient satisfaction in 82% of patients with both dystrophic and non-dystrophic pathologies, but there was a relatively high failure rate (26%) when poor outcomes were analysed. Overall function was better in patients with dystrophic conditions which correlated with better range of movement; however, patients with non-dystrophic conditions achieved greater functional improvement

We report our results and technique of scapulothoracic fusion. 14 fusions were performed in 10 patients between 2001 and 2005. The underlying diagnosis was fascioscapulohumeral dystrophy in 7 patients (11 cases). The diagnosis in the remaining three patients was failure of scapular suspension due to C4/5 tetraplegia, stroke and cerebral palsy. There were five women and five men with an average age of 35.4 years (range 15–75) In each case the medial scapular border was wired to the ribs with the support of a one-third semi-tubular plate and autologous bone graft. We compared pre and post-operative active forward flexion and abduction. Satisfaction with the procedure was also rated. There was no need for single-lung ventilation or a chest drain and there were no significant post-operative complications. There were two cases of non-union. One patient, a heavy smoker, travelled abroad and has been lost to follow-up, the other aged 76 is awaiting revision surgery. The mean range of preoperative active forward flexion and abduction were 71° (range 30–90°) and 58° (range 40–90°) respectively. The mean post-operative values were 96° (90–120°) and 94° (80–120°) respectively. The remaining 8 patients were enthusiastic or satisfied with the result of the operation. This technique was very successful in 12 out of our 14 cases (85.7%) and is to be recommended. However, union may be unpredictable in older patients

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