title: The outcome of scapulothoracic fusion for painful winging of the scapula in dystrophic and non-dystrophic conditions.
abstract: 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.
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Sewell
authors.forename: D S
authors.initials: DS
authors.lastname: Higgs
authors.forename: N
authors.initials: N
authors.lastname: Al-Hadithy
authors.forename: M
authors.initials: M
authors.lastname: Falworth
authors.forename: I
authors.initials: I
authors.lastname: Bayley
authors.forename: S M
authors.initials: SM
authors.lastname: Lambert
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000209:etiology; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications*; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011187:Posture; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D012540:Scapula / Q000002:abnormalities* / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013122:Spinal Diseases / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult