search for



Scapular Dyskinesis Assessment with Low Dose Three-Dimensional Wing Computer Tomography after Anatomical Union of Clavicle Fracture
Korean J Sports Med 2019;37:149-154
Published online December 1, 2019;  https://doi.org/10.5763/kjsm.2019.37.4.149
© 2019 The Korean Society of Sports Medicine.

Yoon-Seok Kim1, Jung-Gon Kim1, Jung-Taek Hwang2, Jae Chan Shim3, Suk-Hwan Jang1

1Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, 2Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 3Department of Radiology, Inje University Sanggye Paik Hospital, Seoul, Korea
Correspondence to: Suk-Hwan Jang
Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea
Tel: +82-2-2270-0028, Fax: +82-2-2270-0023, E-mail: jsh@paik.ac.kr
Received September 18, 2019; Revised September 27, 2019; Accepted October 13, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: Malunions after clavicle fractures are generally considered to cause scapular dyskinesis. This study aims to verify the incidence of scapular dyskinesis following anatomically reduced clavicle fracture and to verify the usefulness of low-dose three-dimensional (3D) scapular wing computed tomography (3D-scapula wing-CT) analysis.
Methods: Twenty-four patients with mid-clavicle fracture and four patients with distal clavicle fracture were recruited. After anatomical reduction and bony union, scapular dyskinesis was assessed by history taking and physical examination by two orthopedic doctors. The mean follow-up period for the assessment was 14.3짹10.1 months. Low-dose 3D-scapular wing-CT analysis in prone position was performed with calculated effective dose 2.35 mSv, which means approximately 25% dose of conventional setting. Four observers evaluated five angles (upward rotation, internal rotation, anterior tilting, superior translation, protraction) from 3D-reconstructed images on both shoulders of a patient. Authors analyzed the results between injured to normal shoulder.
Results: Scapular dyskinesis or significant shortening of injured clavicle (mean clavicle length difference, 닋1.77짹6.36 mm) were not observed among the included 28 subjects. The difference values of the five angles between the fractured side and normal side showed no statistical significance (upward rotation: 1.51, p=0.13; superior translation: 0.89, p=0.327; anterior tilting: 1.7, p=0.096; protraction: 0.83, p=0.374; internal rotation: 0.98, p=0.406). As the interclass correlation coefficients of four observers was 0.988 (p=0.00), images from low-dose 3D-wing-CT are clear enough to assess scapular dyskinesis (interclass correlation coefficient, 0.996; p=0.00).
Conclusion: It is important to make anatomical reduction and length restoration of clavicle fracture for preventing scapular dyskinesis. Low-dose 3D-scapular wing-CT is an effective tool for assessing scapular dyskinesis, which provides images of sufficient quality with little increase in morbidity from radiation hazard.
Keywords : Clavicle fracture, Radiation dosage, Scapular dyskinesis, Three-dimensional computed tomography
References
  1. Donnelly TD, Macfarlane RJ, Nagy MT, Ralte P, Waseem M. Fractures of the clavicle: an overview. Open Orthop J 2013;7:329-33.
    Pubmed KoreaMed CrossRef
  2. Huttunen TT, Launonen AP, Berg HE, Lepola V, Fellander-Tsai L, Mattila VM. Trends in the incidence of clavicle fractures and surgical repair in Sweden: 2001-2012. J Bone Joint Surg Am 2016;98:1837-42.
    Pubmed CrossRef
  3. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res 1994;(300):127-32.
    CrossRef
  4. Van Tassel D, Owens BD, Pointer L, Moriatis Wolf J. Incidence of clavicle fractures in sports: analysis of the NEISS Database. Int J Sports Med 2014;35:83-6.
    Pubmed CrossRef
  5. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am 2003;85:790-7.
    Pubmed CrossRef
  6. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma 1998;12:572-6.
    Pubmed CrossRef
  7. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD;Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 2005;19:504-7.
    Pubmed CrossRef
  8. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med 2010;44:300-5.
    Pubmed CrossRef
  9. Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg 2012;20:364-72.
    Pubmed CrossRef
  10. Keenan KE, Skedros JG. A patient with clavicle fracture and recurrent scapular winging with spontaneous resolutions. Case Rep Orthop 2012;2012:603726.
    Pubmed KoreaMed CrossRef
  11. Rasyid HN, Nakajima T, Hamada K, Fukuda H. Winging of the scapula caused by disruption of 쐓ternoclaviculoscapular linkage: report of 2 cases. J Shoulder Elbow Surg 2000;9:144-7.
    Pubmed CrossRef
  12. Shields E, Behrend C, Beiswenger T, et al. Scapular dyskinesis following displaced fractures of the middle clavicle. J Shoulder Elbow Surg 2015;24:e331-6.
    Pubmed CrossRef
  13. Park JY, Hwang JT, Oh KS, Kim SJ, Kim NR, Cha MJ. Revisit to scapular dyskinesis: three-dimensional wing computed tomography in prone position. J Shoulder Elbow Surg 2014;23:821-8.
    Pubmed CrossRef
  14. Smekal V, Deml C, Irenberger A, et al. Length determination in midshaft clavicle fractures: validation of measurement. J Orthop Trauma 2008;22:458-62.
    Pubmed CrossRef
  15. Park JY, Hwang JT, Kim KM, Makkar D, Moon SG, Han KJ. How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography. A new diagnostic modality. J Shoulder Elbow Surg 2013;22:1084-91.
    Pubmed CrossRef
  16. Karduna AR, McClure PW, Michener LA. Scapular kinematics:effects of altering the Euler angle sequence of rotations. J Biomech 2000;33:1063-8.
    CrossRef
  17. Lenza M, Buchbinder R, Johnston RV, Ferrari BA, Faloppa F. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev 2019;1:CD009363.
    CrossRef
  18. Ristevski B, Hall JA, Pearce D, Potter J, Farrugia M, McKee MD. The radiographic quantification of scapular malalignment after malunion of displaced clavicular shaft fractures. J Shoulder Elbow Surg 2013;22:240-6.
    Pubmed CrossRef
  19. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007;37:1-332.
    CrossRef
  20. American Association of Physicists in Medicine. Policies &procedures: AAPM position statement on radiation risks from medical imaging procedures [Internet]. Alexandria (VA):American Association of Physicists in Medicine; c2018 [cited 2018 Oct 4].