50.Scapula

Question 1

what muscles insert on the acromion and the supraglenoid tubercle respectively

Answer 1

acromion–acromion head of the deltoid musclesupreglenoid tubercle–origin of biceps brachia muscle

Question 2

nerve present in cranial scapular notch

Answer 2

suprascapular nerve emerges cranial to notch and travels caudally

Question 3

where is the axillary nerve found in respect to the scapula

Answer 3

axillary nerve emerges from the caudal border of the subscapularis muscle and crosses the caudal aspect of the scapulohumeral joint

Question 4

radiographic view of scapular to assess for scapular fractures

Answer 4

Roush et aldistoproximal or axial view of the scapula

Question 5

type I, II and III fractures of scapula

Answer 5

I. body and spine (includes acromion)II. neckIII. glenoid (includes supraglenoid)other classification: stable extraarticular, unstable extraarticular, articular

Question 6

surgical stabilization for scapular body fractures`

Answer 6

bone plates (locking, inverted tubular plates)interfragmentary wireplates + wiretotal scapulectomypartial scapulectomy+/- Velpeau

Question 7

screw purchase and bone depth for plating the scapula

Answer 7

bone depth greater cranially in the ventral halfbone depth greater caudally in the dorsal halfangle screws 45 degrees to spine to increase bone purchase

Question 8

T/Fno significant difference in cyclic testing of plated scapular fracture with single vs double plate

Answer 8

TRUEno sign difference in cyclic testing

Question 9

T/Fcase series with 60% scapulectomy had an excellent recovery

Answer 9

TRUE

Question 10

ideal repair for acromion fractures

Answer 10

under tensile strength of acromion head of deltoid musclefix with pins/wires and tension band

Question 11

T/Finjury to the supra scapular nerve will result in decreased sensation to the affected limb

Answer 11

FALSEinjury to the supra scapular nerve will NOT affect distal limb function or cutaneous sensationwill cause atrophy of supra and infraspinatus muscles

Question 12

approaches to the neck of the scapula

Answer 12

cranial or craniolateral or intermuscular approachavoid supra scapular nerve+/- osteotomy of acromion+/- tenotomy of acromion head of the deltoid muscle

Question 13

additional exposure to lateral scapular neck fractures can be achieved with…

Answer 13

osteotomy of greater tubercletenotomy of infraspinatus and/or teres minor muscles

Question 14

repair methods of the scapular neck

Answer 14

1. cross pin fixation (excessive exposure needed to see glenoid and supraglenoid tubercle)2. divergent pin fixation (pins originate at supraglenoid tubercle3. plate fixation (small, T plate) placed cranially to scapular spine on ventral scapula–slide plate under supra scapular nerve

Question 15

at what age should the supraglenoid tubercle fuse

Answer 15

5 months

Question 16

most common intra articular scapular fracture

Answer 16

CRANIAL glenoid fractures (including the supraglenoid tubercle)

Question 17

approaches to scapula for repair of a glenoid fracture

Answer 17

1. cranial with osteotomy of greater tubercle 2. cranial with longitudinal myotomy of supraspinatus3. Cranial with tenotomy of infraspinatus and/or teres minor

Question 18

stabilization of the supraglenoid tubercle

Answer 18

1. lag screw and antirotational pin2. two K wires and figure eight3. excision of supraglenoid tubercle with biceps brachia tenodesis

Question 19

scapular luxation/avulsions occur due to rupture of what muscle

Answer 19

serratus ventralis+/- rhombodeius and trapezius

Question 20

treatment or stabilization recommendation for scapular avulsion

Answer 20

20-22 gauge cerclage passed around 5, 6, or 7 rib and holes drilled in caudal dorsal border of scapulareconstruct serratus ventralis +/- Velpeau

Question 21

incidental findings of the caudal glenoid

Answer 21

ununited accessory caudal glenoid ossification centercheck bilaterallyoften incidentalcan deride if needed