• Qiang He, Jian Jia, and Yu Zhang.
• Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Jul 1; 28 (7): 793-7.

ObjectiveTo investigate the effectiveness of posterior minimally invasive approach for internal fixation of displaced scapula fractures.MethodsBetween January 2006 and December 2011, 16 patients with scapular fractures underwent surgical fixation by a minimally invasive approach, including 11 cases of displaced glenoid fractures and 5 cases of unstable scapular necklbody fractures. There were 12 males and 4 females, aged 35-69 years (mean, 53 years). The causes of injury were traffic accident in 10 cases, falling from height in 4 cases, and tumble in 2 cases. In 11 cases of displaced glenoid fractures, 6 were rated as Ideberg type II, 2 as Ideberg type III, 1 as Ideberg type IV, and 2 as Ideberg type V, with a fracture displacement of more than 3 mm. In 5 cases of unstable scapular necklbody fractures, there were 3 cases of scapular neck fractures and 2 cases of scapular body fractures, with a fracture end angulation of more than 20°; 3 cases had floating shoulder injury. The interval of injury and operation was 4-14 days (mean, 6 days).ResultsThe mean operation time was 105.8 minutes; the mean intraoperative blood loss was 105.8 mL, and the mean hospitalization time was 17.6 days. Three patients had inflammation around the surgical incision, which was controlled by change dressing; primary healing of incision was obtained in the others. The patients were followed up 12-36 months (mean, 24 months); all fractures healed within 12-19 weeks (mean, 15.8 weeks). There was no implant failure or deep infection. Constant shoulder score, disability of the arm, shoulder, and hand (DASH) score, and visual analogue scale (VAS) score at post-operation had a significant improvement when compared with scores at pre-operation (P < 0.05), but no significant difference was found between different time points at post-operation (P > 0.05). Shoulder joint activities were gradually restored during the follow-up; the shoulder range of motion in elevation, abduction, internal rotation, and external rotation at 12 months after operation and last follow-up were significantly higher than those at 6 months after operation (P < 0.05), but difference was not significant between at 12 months and last follow-up (P > 0.05).ConclusionPosterior minimally invasive approach for internal fixation has good effectiveness in treating displaced scapula fractures, with the advantages of no need for a large subcutaneous flap and an extensive Judet incision or creation of muscular flaps.

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