Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences

Boileau, Pascal; Pison, Alexis; Wilson, Adam; Meijden, Olivier van der; Sacconi, Sabrina; Trojani, Christophe; Gauci, Marc-Olivier

doi:10.1016/j.jse.2019.10.006

Cited by 9 publications

(14 citation statements)

References 31 publications

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“…Several authors also reported improvement in clinical scores as well. DASH and the Constant scores tend to improve significantly following STA ( 23 , 25 , 33 , 53 ). Boileau et al ( 23 ) reported a mean increase of 37 points in Constant scores as well as a mean 17 point of improvement in University of California Los Angeles (UCLA) scores.…”

Section: Clinical and Functional Resultsmentioning

confidence: 92%

“…DASH and the Constant scores tend to improve significantly following STA ( 23 , 25 , 33 , 53 ). Boileau et al ( 23 ) reported a mean increase of 37 points in Constant scores as well as a mean 17 point of improvement in University of California Los Angeles (UCLA) scores. Cooney et al ( 25 ) also described a mean improvement of 14 points in DASH scores.…”

Section: Clinical and Functional Resultsmentioning

confidence: 92%

“…Historically, a cast or similar braces were utilized to provide an absolute protection for scapula ( 21 , 22 , 63 ). More recent publications support the use of an arm sling, from 6 weeks ( 20 , 23 , 29 , 32 ) to 3 months ( 21 , 22 , 25 , 26 ). We prefer to immobilize the shoulder in a sling, in 30° of abduction for 10 weeks.…”

Section: Postoperative Period and Rehabilitationmentioning

confidence: 98%

“…The main objective of STA is to eliminate scapular instability and restore the contribution of the glenohumeral joint to shoulder motion. The expected outcome of the surgery is variable ( 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ); however, the current literature reports that 120° of elevation may be achieved ( 19 ). The functional outcome is dependent on the preoperative strength, scapula position and glenohumeral motion.…”

Section: Patient Evaluation and Surgical Indicationmentioning

confidence: 99%

“…STA using screws and tibia strut grafts was first described by Howard et al in 1961 ( 18 ), to stabilize the scapula to provide a stable point of rotation for the humerus. Since then, various modifications have been proposed, utilizing different types of implants, ranging from relatively non-rigid methods such as tapes to rigid plate-screw structures ( 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ).…”

Section: Introductionmentioning

confidence: 99%

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Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes

et al. 2022

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Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition. Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle. There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft. The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores. There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon. In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.

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Section: Clinical and Functional Resultsmentioning

confidence: 92%

Section: Clinical and Functional Resultsmentioning

confidence: 92%

Section: Postoperative Period and Rehabilitationmentioning

confidence: 98%

Section: Patient Evaluation and Surgical Indicationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes

et al. 2022

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In silico analysis of rib force distribution in postscapulothoracic arthrodesis model

Aslan,

Subasi,

Gedik

et al. 2024

Journal Orthopaedic Research

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Scapulothoracic arthrodesis (STA) is carried out by fixing the scapula to thoracic ribs which in turn allows the patient suffering from Facioscapulohumeral Muscular Dystrophy to carry out shoulder‐joint dependent activities of daily living. A biomechanical analysis of this procedure has not been conducted in the literature and, for the first time, this study investigates the finite element calculated glenohumeral‐applied load distributions on ribs by creating a post‐STA model. Three loading directions on the glenohumeral joint are designated: anterior‐posterior, superior‐inferior, and lateral‐medial. Reaction forces on the ribs are calculated based on the glenoid force percent. Simulations are repeated by removing a singular rib contact to observe the change in force distributions in the case of missing levels or failed bonding as well as the impact of clavicle osteotomy. Total load distribution is observed highest at T2 followed by T3 and T6. In the T2 missing scenario, total loads on T3 and T4 increase. In the T4 missing case, the most affected level is T3. In the T6 missing scenario, total loads on T5 and T7 increase. In the clavicular osteotomy scenario, all levels' loads increase; the highest is recorded in T7 by 460%, followed by T5, T4, T2, T6, and T3. While all levels contribute to fixation strength, T2 is subjected to the highest loads, and, in the missing level scenarios, the loads are tolerated sufficiently by the remaining levels. Missing T4 scenario has the least effect on the system, which is interpreted as potentially the only skippable level of fixation. Clavicular osteotomy has the highest effect on the arthrodesis site.

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Outcomes of scapulothoracic fusion in patients with facioscapulohumeral dystrophy: a comparison of allograft versus autograft bone grafting

Lohre

Elhassan

2023

Journal of Shoulder and Elbow Surgery

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Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences

Cited by 9 publications

References 31 publications

Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes

Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes

In silico analysis of rib force distribution in postscapulothoracic arthrodesis model

Outcomes of scapulothoracic fusion in patients with facioscapulohumeral dystrophy: a comparison of allograft versus autograft bone grafting

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