Determining the mechanism of injury can be helpful in narrowing the search for additional injuries. Careful attention should be paid to the identification of neck pain and back pain, and a thorough neurological examination of the injured extremity is essential. Cervical spine and brachial plexus injuries are common, occurring in up to 7% of scapular fractures and significantly affecting patient outcomes. Pulses should be felt, documented, and compared with the contralateral extremity. Skin examination is crucial, not only for identifying open fractures, but also for evaluating the integrity of the soft-tissue envelope, which can dictate operative timing and necessitate local wound care, delaying surgery. Advanced Trauma Life Support (ATLS) protocols should be followed. Chest radiograph is important for the identification of fractured ribs or a pneumothorax and lateral cervical spine radiographs also should be obtained.
The physical examination of patients with traumatic scapular fractures should focus on identifying life-threatening injuries and those that, if unrecognized, can lead to progressive deformity and loss of function such as spine, cranium, or thoracic injuries. Reported rates of head, thoracic, and great vessel injuries in patients with high-energy shoulder girdle injuries were found to be 31.5%, 36.8% and 3.9% respectively. Baldwin et al. found in over 9,400 scapular fractures retrospectively identified from the National Trauma Database, that rib fractures were present in 52.9%, spinal fractures in 29.1%, lung injuries in 47.1%, head injuries in 39.1%, and clavicular fractures in 25.2% of patients. Additional injuries were identified in 90% of patients, ipsilateral injury in 50%, thoracic injury in 80%, head injuries 48%, and spine fractures 26%.
Curr Orthop Pract. 2015;26(2):99-104. © 2015 Lippincott Williams & Wilkins