Scapular Fractures: Diagnosis and Treatment Plan

Timothy B. Alton; Michael J. Gardner

Disclosures

Curr Orthop Pract. 2015;26(2):99-104. 

In This Article

Abstract and Introduction

Abstract

Scapular fractures are common in polytraumatized patients and should alert treating providers to investigate for additional severe, often life-threatening injuries. While many fractures can be treated nonoperatively, surgical intervention is required if fractures are widely displaced or involve significant portions of the glenoid articular surface. The osseous anatomy of the scapula is complicated and thin, which dictates fixation options. Many classifications exist for scapular fractures and, while the AO/OTA recently contributed the New International Classification for Scapular Fractures, surgical indications remain loosely defined. Advanced imaging, such as three-dimensional CT scans, help in the diagnosis and surgical planning. The glenoid and scapular neck can be approached anterior, via the deltopectoral interval, while the posterior scapula is accessed through the modified Judet approach.

Introduction

Scapular fractures represent 3–5% of all shoulder girdle fractures, often present in polytraumatized patients after high-energy injuries.[1,2] Additional ipsilateral extremity fractures are common, and the presence of a scapular fracture should alert the treating physician to the possibility of additional severe, even life-threatening injuries. Historical treatment of scapular body fractures has been benign neglect as the blood supply is robust, union rates are high, and most patients achieve acceptable functional outcomes. Fractures of the glenoid articular surface, however, are articular injuries that tolerate less deformity and often require surgery if displaced.[3] The shoulder joint has a range motion that greatly exceeds what is needed for activities of daily living, allowing compensation for scapular body and neck fracture malunion. This malunion, however, results in a functional change in either strength, range of motion, endurance or reaction time of the shoulder girdle. This change is yet to be fully quantified, is not well understood, and is the driving force behind expanding surgical indications.[4]

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