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Fixation of Winged Scapula in Facioscapulohumeral Muscular Dystrophy

Sandro Giannini, MD, Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy
Cesare Faldini, MD, Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy
Stavroula Pagkrati, MD, Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy
Gianluca Grandi, MD, Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy
Vitantonio Digennaro, MD, Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy
Deianira Luciani, MD, Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy
Luciano Merlini, MD, Muscle Unit, Division of Medical Genetics, Department of Experimental and Diagnostic Medicine, University of Ferrara, Italy

Reprint Requests: Prof. Sandro Giannini, Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli Via G. Pupilli 1, 40136 Bologna Italy, Tel: +39 051583217, Email: giannini{at}ior.it

Objective: To verify if stabilizing the scapulothoracic joint without arthrodesis could lead to functional improvement of shoulder range of motion and clinical improvement of winged scapula, we incorporated four additional patients into our previous analysis to determine if the results obtained were long lasting, and to compare this fixation with the other techniques described in the literature, balancing the benefits with the complications.

Design: A retrospective study.

Participants: Thirteen patients with bilateral winged scapula affected by facioscapulohumeral muscular dystrophy. Nine of these patients had been analyzed in our previous study.

Methods: Patients were operated on by bilateral fixing of the scapula to the rib cage using metal wires without arthrodesis (scapulopexy).

Results: All patients experienced improvement in active range of motion of the shoulder and all of them had clinical improvement with complete resolution of the winged scapula. In all twenty-six surgical interventions of scapulopexy, a stable and long-lasting fixation of the scapula to the rib cage was achieved.The complications strictly associated to the surgical technique encountered were one pneumothorax, which was resolved spontaneously, and one wire breakage without trauma. Average follow-up was 10 years (range, 3 to 18 years).

Conclusion: The scapulopexy used in this extended series of patients consisted of repositioning the scapula and fixing it to four ribs by using metal wires without performing arthrodesis.This technique has a low rate of complications, is reproducible, safe and effective, resulting in clinical and functional improvement.

Key Words: Muscular dystrophy • Scapulopexy • Winged scapula