Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures – A multi-observer study

Abstract

Introduction: Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. Methods: Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. Results: The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. Conclusion: Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.

Scapular spine fracture, presentation of two cases and novel surgical treatment

“…This technique can be used in primary and revision setting in cases of failed open reduction internal fixation with conventional methods. Precontouring the plate (Charilaou 4 technique) in the office saved time in operating room and facilitate reduction of the fracture in to the plate ( Fig. 4 ).…”

“…Immediately after failure of fixation, patient denied revision surgery but after a year due to poor pain control and poor function decided to come back for treatment. Author contemplated using 3-dimensional (3D) printed model and precontour lateral clavicle locking plate in the office based on the reduced fracture segment on 3D model 4 and augmented it with strut allograft in supraspinatus fossa and packing the space between spines of scapula to allograft with cancellous bone graft. Subsequently, author used similar technique in another case.…”