Scapulothoracic Fusion for Fascio-Scapulo-Humeral Dystrophy

Abstract

Background

Scapulothoracic (ST) fusion has been recommended for suitable patients suffering from FacioScapuloHumeral Dystrophy (FSHD). It helps in creating a fulcrum for the deltoid and prevents winging of the scapula during flexion and abduction of the arm, thus improving activities of daily living. We present here an overview of the techniques used and the results of 9 ST fusion carried out at our department.

Method

The scapula is fixed to the underlying rips using Luque wires around the 2^nd to 6^th ribs, then passed through the medial border of the scapula, then through an 8 hole semi tubular plate placed over the dorsal aspect of the whole medial border of the scapula. After which the Luque wires are tied firmly, locking the scapula onto the chest wall. Morsellised bone allograft is placed between the scapula and the ribs before tightening the wires.

Results

In total 9 ST fusions were carried out. No Intra-operative complications occurred but 2 patients developed haemothoraces post-operatively, one resolved with chest drain and one needed thoracotomy. Late complications included one scapula fracture (subsequently internally fixed), one frozen shoulder (resolved with physiotherapy) and one protruding plate (subsequently removed). An average of 40 degrees of additional abduction was achieved and overall good patients satisfaction.