Identification of recurring scapula fracture patterns using Three-Dimensional Computerised fracture mapping.

Abstract

BACKGROUND\nScapula fracture fixation and implant selection are guided by the fracture pattern and classification which requires accurate understanding and interpretation of the fracture lines. Three-Dimensional (3D) Computed Tomography (CT) based fracture pattern analysis enhances a more accurate understanding of the scapula fracture patterns. The purpose of this study was to create scapula fracture maps and identify the frequent fracture patterns using 3D reconstructed CT images.\n\n\nMETHOD\nSeventy patients treated for scapular fractures, in a single hospital, were considered for this study. Their CT images were reconstructed into three-dimensional models (3D) and the fracture fragments were virtually reduced. The reduced 3D models were first aligned on a 3D template and 2D images were captured on the Anterior View (AV), Posterior View (PV), and Lateral View (LV). Then each fracture image was aligned on a corresponding 2D template, and the fracture lines were transferred to the template. The three separate views were used to accurately capture the propagation and exit of the fractures through the scapula anatomy. These fracture lines were compiled, and heat maps were generated to identify the frequent fracture zones of the scapula.\n\n\nRESULT\nThe observed scapula fractures propagated through multiple regions of the bone. Overall, the three most common exit zones in the scapula borders were, lateral border (69%), medial border (67%), and superior border (60%). More specifically, superior lateral border, medial base of the scapula spine, spinoglenoid notch, and mid superior border were the frequent zones of fracture in the scapula body. Simple intraarticular fractures (transverse or oblique type) were the most common (92%) fracture type in the glenoid region.\n\n\nCONCLUSION\nScapula fractures reveal repeatable patterns. The zones of recurrent fracture patterns can be identified from the fracture and heat maps. The graphical plot of fracture and heat maps may assist surgical planning and implant design optimization.