A Comparison of Exposure Between the Classic and Modified Judet Approaches to the Scapula

Harmer, Luke; Phelps, Kevin D.; Crickard, Colin V.; Sample, Katherine M.; Andrews, Erica; Hamid, Nady; Hsu, Joseph R.

doi:10.1097/bot.0000000000000486

Cited by 20 publications

(21 citation statements)

References 25 publications

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“…1,19 In the present study, the percentages of instability and malunion were 0.0% and 0.0%, respectively, for the ring-treated group; and 5.3% and 5.3%, respectively, for the non-ring-treated group during the final follow-up, which were in agreement with previous findings. 1,14,19 Some researchers have highlighted that the rates of instability and malunion were higher after utilizing non-ring fixation than ring fixation. 5,19,21,24 Furthermore, the current study demonstrated higher rates than those published in some previous reports, 25,26 but the rates were lower than those published in the more recent reports.…”

Section: Discussionsupporting

confidence: 93%

“…16,18,19 Generally, a higher clinical complication rate has been detected after non-ring plate fixation than after ring plate fixation. 1,19 In the present study, the percentages of instability and malunion were 0.0% and 0.0%, respectively, for the ring-treated group; and 5.3% and 5.3%, respectively, for the non-ring-treated group during the final follow-up, which were in agreement with previous findings. 1,14,19 Some researchers have highlighted that the rates of instability and malunion were higher after utilizing non-ring fixation than ring fixation.…”

Section: Discussionmentioning

confidence: 99%

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Ring versus non-ring plate for the treatment of displaced scapular body fractures: a retrospective study with a mean follow-up of 5 years

et al. 2018

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ObjectiveTo compare surgical complications and functional outcomes of the ring plate versus the non-ring plate approach to the surgical repair of scapular body fractures (SBFs; AO/OTA classification: 14-A2.2).MethodsThis retrospective study reviewed data from adults with SBFs who underwent a modified Judet approach combined with non-ring or ring plates between November 2006 and June 2013. The primary outcomes were the Constant and Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) score. The secondary outcomes were radiographic findings.ResultsA total of 318 patients had a non-ring or ring plate internal fixation, of which 147 patients (ring-treated, n = 72; non-ring-treated, n = 75) were evaluated with a mean follow-up period of 60 months. At the 3-month follow-up, the complication rate was 2.8% and 13.3% for the ring-treated and non-ring-treated groups, respectively. The difference persisted over time, with significantly different rates of 8.3% and 20.0% at the final follow-up for the ring and non-ring groups, respectively. The ring-treated group had significantly higher postoperative Constant and Murley scores and lower DASH scores compared with the non-ring-treated group.ConclusionApplication of a modified Judet approach combined with ring plate internal fixation for the treatment of SBFs may be the preferred treatment option.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Ring versus non-ring plate for the treatment of displaced scapular body fractures: a retrospective study with a mean follow-up of 5 years

et al. 2018

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“…Harmer et al showed, in a cadaveric study, that the MJ approach exposes only 20 % of the area visualized with CJ but allows similar access to important landmarks for reduction and fixation, minimizing soft-tissue excision [9]. …”

Section: Discussionmentioning

confidence: 99%

“…In 1964, Judet described a posterior approach, which required infraspinatus muscle lateral reflection to expose the infraglenoid fossa and the posterior part of the scapular neck; this approach is known as the classic Judet approach [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

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Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference?

et al. 2018

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BackgroundSurgical treatment of scapular fractures with posterior approach is frequently associated with postoperative infraspinatus hypotrophy and weakness. The aim of this retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with the classic Judet versus modified Judet approach for scapular fracture.Patients and methods20 cases with scapular neck and body fracture treated with posterior approach for lateral border plate fixation were reviewed. In 11 of 20 cases, we used the modified Judet approach (MJ group), and in 9 cases we used the classic Judet approach (CJ group). All fractures were classified according to the AO classification system. At follow-up examinations, patients had X-ray assessment with acromiohumeral distance (AHD) measurement, clinical evaluation, active range of motion (ROM) examination, Constant Shoulder Score, and Disability of the Arm, Shoulder and Hand (DASH) Score. Infraspinatus strength assessment was measured using a dynamometer during infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT).ResultsDemographic data did not significantly differ between the CJ group and MJ group, except for mean follow-up, which was 4.15 years in the CJ group and 2.33 in the MJ group (p < 0.001). All X-ray examinations showed fracture healing. AHD was significantly decreased in the CJ group (p = 0.006). We did not find significant differences in active ROM between the MJ and CJ groups in the injured arm (p < 0.05). The Constant Score was 75.83 (±14.03) in the CJ group and 82.75 (±10.72) in the MJ group (p = 0.31); DASH Score was 10.16 in the CJ group and 6.25 in the MJ group (p = 0.49). IST showed mean strength of 8.38 kg (±1.75) in the MJ group and 4.61 kg (±1.98) in the CJ group (p = 0.002), ISRT test was 8.7 (±1.64) in the MJ group and 4.95 (±2.1) in the CJ group (p = 0.002). Infraspinatus hypotrophy was detected during inspection in six patients (five in the CJ group and one in the MJ group); it was related to infraspinatus strength weakness in IST and ISRT (p < 0.001).ConclusionsInfraspinatus-sparing surgical approach for scapular fracture avoids infraspinatus hypotrophy and external-rotation strength weakness. We suggest use of the modified Judet approach for scapular fracture and to restrict the classic Judet approach to only when the surgeon believes that the fracture is not easily reducible with a narrower exposure.Level of evidenceLevel IV.

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Special Considerations: Complex Scapular Fractures—Preoperative Planning and Fixation Strategies (Case Based)

Giordano,

Pires,

Labronici

2024

Fractures of the Scapula

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A Comparison of Exposure Between the Classic and Modified Judet Approaches to the Scapula

Abstract: In conclusion, the MJ approach allows similar access to landmarks important for reduction and fixation while exposing only 20% of the surface area typically visualized with the CJ approach.

Cited by 20 publications

References 25 publications

Ring versus non-ring plate for the treatment of displaced scapular body fractures: a retrospective study with a mean follow-up of 5 years

Ring versus non-ring plate for the treatment of displaced scapular body fractures: a retrospective study with a mean follow-up of 5 years

Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference?

Special Considerations: Complex Scapular Fractures—Preoperative Planning and Fixation Strategies (Case Based)

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