Session III - Reconstruction

Thurs., 10/5/06 Reconstruction, Paper #14, 4:36 pm

The Radiographic Quantification of Scapular Winging following Malunion of Displaced Clavicular Shaft Fractures

Jeremy A. Hall, MD (n); Michael D. McKee, MD (n); Dawn Pearce, MD (n);
Jeff Potter, BSc (a-St. Michael's Hospital Summer Research Funding);
Michael Feruggia, BSc (a-St. Michael's Hospital Summer Research Funding);
St. Michael's Hospital, University of Toronto, Toronto, Ontario Canada

Purpose: 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.

Methods: 11 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 standardized 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.

Results: The mean time from fracture was 27 months. There were 9 males and 2 females with a mean age of 37.4 years. The mean clavicular shortening was 14 mm (P >0.001). The mean anterior rotation through the malunion was 8°, and showed a trend toward significance (P = 0.1). The scapula was displaced laterally 9.8 mm (P >0.001) from the nearest spinous process, superiorly 14.4 mm and 9.4 mm (P >0.001) off the chest wall on average compared to the opposite normal shoulder.

Conclusion/Significance: 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 shoulder girdle function.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.