Scapular Fractures: Diagnosis and Treatment Plan

Timothy B. Alton; Michael J. Gardner


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

In This Article


Historically, scapular fracture classification systems have been described based primarily on expert opinion without providing surgical indication or stringent validation and have thus failed to gain widespread acceptance.[11–13,14] In 2012 the Orthopaedic Trauma Association (OTA) classification committee and the AO Classification Advisory published the New International Classification for Scapular Fractures. This study group created a schema for fracture classification based on the unique osteology of the scapula. Fractures are divided into two categories: those involving the processes (acromion, coracoid) or those involving the body or fossa (Figure 1).[15] Fossa fractures are subdivided into (1) rim, (2) simple split fractures, and (3) complex joint fractures. Process fractures involve either the acromion or coracoid. Body fractures are further subdivided as (1) simple with a single fracture line and one or no border exit, (2) simple with one fracture line and two border exit points, and (3) multifragmentary with three or more border exits.[15] They found that the addition of CT scans increased the full reviewer agreement from 49–65% and kappa improved from 0.59–0.78.[15] Subsequent studies of 120 consecutive scapular fractures using plain films and three-dimensional (3D) CT scans evaluated the accuracy of fossa[16] and body[17] fracture subdivisions and confirmed the reliability of this classification system. Neuhaus et al.[18] compared the original AO/OTA classification for scapular fractures with the New International Classification for Scapula Fractures and found the New International Classification to have a better proportion of rater agreement (81% vs 71%).[13,18]

Figure 1.

New International Classification for Scapular Fractures that divides injuries into process, body, or fossa fractures. (Reproduced with permission from (Harvey et al. J Orthop Trauma. 2012; 26:364–369).

Lambert et al.[19] proposed another classification system based on the lateral scapular suspension system and its involvement as an indication for surgery and found a kappa of 0.54 but noted the complexity of this classification to be problematic, even with 3-D CT scans.[19]