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Peter A Cole - One of the best experts on this subject based on the ideXlab platform.
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radiographic correlation of clinical shoulder deformity and patient perception following Scapula Fracture
Injury-international Journal of The Care of The Injured, 2020Co-Authors: Joscelyn M Tatro, Lisa K Schroder, Jeffrey P Anderson, Dylan L Mccreary, Peter A ColeAbstract:Abstract Background Interest in operative management of Scapular Fractures is increasing based upon defined radiographic displacement criteria and growing awareness that certain extra-articular Fractures will not do well and result in dysfunction and deformity (slumped shoulder). We intend to quantify clinical deformity, analyze correlations of these novel measures with defined radiographic measures of Fracture displacement and with the patients’ reported perception of their deformity. Methods Prospectively enrolled patients underwent standardized questioning regarding their perception of the deformity. Radiographs were utilized to measure glenopolar angle medial/lateral displacement, and angulation of the displaced Scapula Fracture. Novel measurements of clinical deformity (shoulder area, shoulder angle and shoulder height difference) were calculated. All measurements were repeated post-operatively for patients undergoing operative treatment. Results Fifty-one patients (39 operative) were examined within 30 days of injury. Follow-up (≥2 months post-op) was obtained for 31/39 (79%). Medial–lateral displacement significantly correlated with all measures of clinical deformity and with patient reported shoulder appearance bothersome score. Angulation significantly correlated with patient perception and two clinical measures (shoulder area and shoulder angle difference). All post-operative radiographic measures, clinical measures of deformity, and patient reported scores statistically improved from baseline measures. Discussion Patients with Scapula Fracture do perceive deformity, and there is a significant correlation between the patients’ perception, radiographic and clinical measurements of deformity after Scapula Fracture. All measures statistically improved in patients with operative treatment compared to baseline measurements. This study reinforces the importance of the clinicians’ clinical examination and observation of shoulder deformity in the Scapula Fracture patient. Level of evidence IV
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injury mechanism epidemiology and hospital trends of Scapula Fractures a 10 year retrospective study of the national trauma data bank
Injury-international Journal of The Care of The Injured, 2019Co-Authors: Joscelyn M Tatro, Lisa K Schroder, Beth A Molitor, Emily D Parker, Peter A ColeAbstract:Abstract Background This 10 year retrospective study of the NTDB is the first to describe trends in Scapula Fracture diagnosis frequency, epidemiology, injury mechanisms and the type of hospital where the condition is treated. Methods Demographics, ISS scores, hospital data, mechanism of injury, complications, and hospital length of stay were recorded for patients with diagnosed Scapula Fractures (ICD-9, 811.0) recorded in the NTDB, v7.2 (2002–2012). Mean and standard deviation for continuous variables and proportions for binary variables are calculated. Results The prevalence of Scapula Fractures in all patients submitted to the NTDB (2002–2012) was 1.74%. Between 2006–2007, the reported incidence doubled from 1% to 2.2%. There was a predominance of injury to white males (75% and 78% respectively). Forty-one percent were treated at a Level 1 trauma center and had a mean ISS of 20.1 (SD-11.8). Scapula Fracture rates declined in patients 0–19 years and increased in the 60–79 and 80+ age groups. The increasing incidence of the aged population is also reflected in the increase of falls as the mechanism of injury in the elderly population. Conclusion This study is the first to describe a full decade of Scapula Fracture epidemiology on a national scale. The number of diagnosed Scapula Fractures increased substantially in the NTDB between 2002-2012. Scapula Fractures diagnosed in the geriatric demographic and Fractures resulting from falls are both on the rise, whereas the reported incidence is decreasing in the younger demographic. Additionally, Fractures as a result of motor vehicle accidents also decreased precipitously during the reported decade.
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functional outcomes of operative management of Scapula Fractures in a geriatric cohort
Journal of Orthopaedic Trauma, 2017Co-Authors: Peter A Cole, Jeffrey A GilbertsonAbstract:OBJECTIVES: To analyze functional outcomes, motion, and strength in patients 65 years of age and older who underwent operative management of a Scapula Fracture. DESIGN: Retrospective review of prospective database. SETTING: A single level-1 teaching trauma center. PATIENTS/PARTICIPANTS: Two hundred fifty patients with Scapula Fractures were operated between January 2002 and March 2014. A review identified 16 geriatric patients 65 years of age and older. INTERVENTION: All patients underwent operative treatment of a Scapular Fracture. MAIN OUTCOME MEASUREMENTS: Disabilities of the Arm, Shoulder, and Hand (DASH), Short-Form Health Survey versions 1 and 2 (SF-36), Range of Motion (ROM), and Strength assessment at final follow-up 1 year or greater. RESULTS: Outcomes were attained on 15/16 patients at a mean follow-up of 40 months (range = 12-114). All Fractures were united. Three patients experienced minor perioperative complications (temporary delirium in 2 patients, urinary tract infection in 1). One patient required subsequent removal of an intraarticular screw, and 1 patient required resection of heterotopic ossification and requested implant removal. The mean ROM expressed as a percent of contralateral ROM ranged from 78% to 96%. The mean strength expressed as a percent of contralateral strength ranged from 76% to 92%. The mean DASH score was 8.4. SF-36 scores were comparable with the normal population. All patients returned to activities. CONCLUSIONS: Operative treatment for displaced Fractures in patients 65 years of age and older is safe and can yield good functional results and return to function. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Surgical management of isolated acromion Fractures: technical tricks and clinical experience.
Journal of Orthopaedic Trauma, 2014Co-Authors: Brian W. Hill, Jack Anavian, Aaron R. Jacobson, Peter A ColeAbstract:SUMMARY: Acromion Fractures of the Scapula are rare and most often occur with concomitant Fractures of the ipsilateral glenoid, neck and body of the Scapula as sequelae of high-energy injuries. Indications for operative management include symptomatic nonunion, displaced Fractures, or acromion Fractures associated with other lesions of the superior shoulder suspensory complex. Less displaced acromion Fractures resulting in decreased subacromial space may also warrant surgery. Although surgical indications have been reported, the literature regarding surgical approaches and fixation techniques for management of these factures is limited. Acromion Fractures can generally be addressed with a direct posterior approach using either tension band or low-profile plating in combination with cortical lag screws to obtain a stable construct. This technique is both effective in achieving Fracture union and safe to the patient. When associated with a more complex Fracture of the glenoid and/or Scapula body, the surgical approach and fixation strategy should be dictated by the optimal approach to other displaced elements of a Scapula Fracture. The purpose of this study was to describe a step-wise approach to the surgical management of isolated acromion Fractures, describe surgical tips and techniques, and to present the early clinical outcomes in 13 patients after surgical treatment with this approach.
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radiographic follow up of 84 operatively treated Scapula neck and body Fractures
Injury-international Journal of The Care of The Injured, 2012Co-Authors: Peter A Cole, Jack Anavian, Erich M Gauger, Diego A Herrera, Ivan S TarkinAbstract:Abstract Background Certain Scapula Fractures may warrant surgical management to restore shoulder anatomy and promote optimal function. The purpose of this study is to determine the early radiographic follow-up of open reduction internal fixation (ORIF) for displaced, Scapular Fractures involving the glenoid neck and body. Methods Eighty-four patients with a Scapula body or neck Fracture (with or without articular involvement) underwent ORIF between 2002 and 2010 at a single level I trauma centre. This study represents a retrospective review of data prospectively collected into a dedicated Scapula Fracture database. All patients met at least one of the following operative criteria: ≥20 mm medial/lateral (M/L) displacement (lateral border offset), ≥45° of angular deformity on a Scapular-Y X-ray, the combination of angulation ≥30° plus M/L displacement ≥15 mm, double disruptions of the superior shoulder suspensory complex both displaced ≥10 mm, glenopolar angle (GPA) ≤22° and open Fractures. Eighty-eight percent (74/84) had sufficient follow-up defined as at least 6 months. Measured outcomes included rates of Scapula union and malunion, as well as surgical complications and re-operations. Results All Fractures were caused by high-energy trauma with 24 (29%) resulting from motor-vehicle collisions. Associated injuries occurred in 94% of patients, most commonly involving the chest (70%) and ipsilateral shoulder girdle (43%). Forty-eight patients had M/L displacement as an operative indication with a mean displacement of 25.7 mm (range = 20–40). Thirty-eight (45%) had ≥2 operative indications. A single surgeon performed ORIF in all patients using a posterior approach. Five patients also required an anterior (deltopectoral) approach. The fixation strategy included lateral and vertebral border stabilisation with dynamic compression and reconstruction plates, respectively. Union was achieved in all cases. There were three cases of malunion based on a GPA difference >10° from the uninjured shoulder. Re-operations included removal of hardware (seven patients) and manipulation under anaesthesia (three patients). There were no infections or wound dehiscence. Conclusions ORIF for displaced Scapula Fractures is a relatively safe and effective procedure for restoration of anatomy and promotion of union. Level of evidence Therapeutic study, level IV.
S A Stapley - One of the best experts on this subject based on the ideXlab platform.
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Scapula INJURIES SUSTAINED BY UK MILITARY PERSONNEL ON OPERATIONS: A TEN-YEAR REVIEW
2018Co-Authors: D.c. Roberts, Dominic Power, S A StapleyAbstract:Scapula Fractures mostly occur following high energy trauma, however, the demographics are unknown in deployed soldiers. We analysed the incidence, aetiology, associated injuries, treatment and complications of these Fractures in military personnel from Afghanistan and Iraq (2004–2014). Forty-four Scapula Fractures from 572 upper limb Fractures (7.7%) were sustained. 85% were caused by blast or gunshot wounds and 54% were open blast Fractures. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores were almost double compared to the average upper limb injury without a Scapula Fracture (21 vs. 11). Brachial plexus injuries (17%) have a favourable outcome following GSW compared to blast injuries. Glenoid Fractures or floating shoulders were internally fixed (10%) and resulted from high velocity gunshot wounds or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all Scapula Fractures united. Scapula Fractures have a ...
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A review of 10 years of Scapula injuries sustained by UK military personnel on operations
Journal of the Royal Army Medical Corps, 2017Co-Authors: D.c. Roberts, Dominic Power, S A StapleyAbstract:Background Scapula Fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of Scapula Fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these Fractures occurring in deployed military personnel. Methods All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004–2014). Results Forty-four Scapula Fractures out of 572 upper limb Fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open Fractures (54%), with open blast Fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a Scapula Fracture (p Conclusion Scapula Fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These Fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.
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Scapula INJURIES SUSTAINED BY UK MILITARY PERSONNEL ON OPERATIONS: A TEN-YEAR REVIEW
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: D.c. Roberts, Dominic Power, S A StapleyAbstract:Scapula Fractures mostly occur following high energy trauma, however, the demographics are unknown in deployed soldiers. We analysed the incidence, aetiology, associated injuries, treatment and complications of these Fractures in military personnel from Afghanistan and Iraq (2004–2014). Forty-four Scapula Fractures from 572 upper limb Fractures (7.7%) were sustained. 85% were caused by blast or gunshot wounds and 54% were open blast Fractures. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores were almost double compared to the average upper limb injury without a Scapula Fracture (21 vs. 11). Brachial plexus injuries (17%) have a favourable outcome following GSW compared to blast injuries. Glenoid Fractures or floating shoulders were internally fixed (10%) and resulted from high velocity gunshot wounds or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all Scapula Fractures united. Scapula Fractures have a 20 times higher incidence in military personnel compared to the civilian population. These Fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.
José J. Cuenca - One of the best experts on this subject based on the ideXlab platform.
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Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma
Intensive Care Medicine, 2012Co-Authors: Victor X. Mosquera, Milagros Marini, Javier Muñiz, Vanesa Asorey-veiga, Belen Adrio-nazar, Ricardo Boix, José M. Lopez-perez, Gonzalo Pradas-montilla, José J. CuencaAbstract:Purpose To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). Methods A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1–4). Results Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone Fracture, pulmonary contusion, left Scapula Fracture, hemothorax, and pelvic Fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden’s index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. Conclusions Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.
D.c. Roberts - One of the best experts on this subject based on the ideXlab platform.
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Scapula INJURIES SUSTAINED BY UK MILITARY PERSONNEL ON OPERATIONS: A TEN-YEAR REVIEW
2018Co-Authors: D.c. Roberts, Dominic Power, S A StapleyAbstract:Scapula Fractures mostly occur following high energy trauma, however, the demographics are unknown in deployed soldiers. We analysed the incidence, aetiology, associated injuries, treatment and complications of these Fractures in military personnel from Afghanistan and Iraq (2004–2014). Forty-four Scapula Fractures from 572 upper limb Fractures (7.7%) were sustained. 85% were caused by blast or gunshot wounds and 54% were open blast Fractures. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores were almost double compared to the average upper limb injury without a Scapula Fracture (21 vs. 11). Brachial plexus injuries (17%) have a favourable outcome following GSW compared to blast injuries. Glenoid Fractures or floating shoulders were internally fixed (10%) and resulted from high velocity gunshot wounds or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all Scapula Fractures united. Scapula Fractures have a ...
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A review of 10 years of Scapula injuries sustained by UK military personnel on operations
Journal of the Royal Army Medical Corps, 2017Co-Authors: D.c. Roberts, Dominic Power, S A StapleyAbstract:Background Scapula Fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of Scapula Fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these Fractures occurring in deployed military personnel. Methods All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004–2014). Results Forty-four Scapula Fractures out of 572 upper limb Fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open Fractures (54%), with open blast Fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a Scapula Fracture (p Conclusion Scapula Fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These Fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.
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Scapula INJURIES SUSTAINED BY UK MILITARY PERSONNEL ON OPERATIONS: A TEN-YEAR REVIEW
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: D.c. Roberts, Dominic Power, S A StapleyAbstract:Scapula Fractures mostly occur following high energy trauma, however, the demographics are unknown in deployed soldiers. We analysed the incidence, aetiology, associated injuries, treatment and complications of these Fractures in military personnel from Afghanistan and Iraq (2004–2014). Forty-four Scapula Fractures from 572 upper limb Fractures (7.7%) were sustained. 85% were caused by blast or gunshot wounds and 54% were open blast Fractures. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores were almost double compared to the average upper limb injury without a Scapula Fracture (21 vs. 11). Brachial plexus injuries (17%) have a favourable outcome following GSW compared to blast injuries. Glenoid Fractures or floating shoulders were internally fixed (10%) and resulted from high velocity gunshot wounds or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all Scapula Fractures united. Scapula Fractures have a 20 times higher incidence in military personnel compared to the civilian population. These Fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.
Victor X. Mosquera - One of the best experts on this subject based on the ideXlab platform.
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Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma
Intensive Care Medicine, 2012Co-Authors: Victor X. Mosquera, Milagros Marini, Javier Muñiz, Vanesa Asorey-veiga, Belen Adrio-nazar, Ricardo Boix, José M. Lopez-perez, Gonzalo Pradas-montilla, José J. CuencaAbstract:Purpose To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). Methods A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1–4). Results Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone Fracture, pulmonary contusion, left Scapula Fracture, hemothorax, and pelvic Fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden’s index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. Conclusions Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.
