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Scapula Fracture
From WikiSM
Contents
Other Names
- Shoulder Blade Fracture
- Scapular Fracture
Background
- This page describes all fractures to the Scapula
Epidemiology
Pathophysiology
- Uncommon
- Almost always associated with high energy trauma
- Less commonly: avulsion, stress, fatigue fracture
Pathoanatomy
- The Scapula acts as part of a dynamic stabilizer of the humerus and shoulder complex[3]
- Can be subdivided into four processes[4]
- Glenoid fossa (15%)
- Acromial Process (8%)
- Coracoid Process (7%)
- Spine and Body (70%)
- Three articulations
- Scapular Stabilizers
- Glenoid Labrum
- Rotator Cuff Muscles
- Joint Capsule]]
- Rhomboid Major
- Rhomboid Minor
- Trapezius
- Levator Scapulae
- Latissimus Dorsi
- And more...
Associated Injuries
- Overall 80-90% chance of associated osseus or soft tissue injuries[4]
- Patients average 3.9 additional injuries
- Rib Fracture (35 - 45%)
- Clavicle Fracture (ipsilateral, 15 - 52%[5])
- Spine Fracture (29.1%[6])
- Pneumothorax
- Pulmonary Contusion
- Head Injury (31.5 - 39.5%)
- Skull Fracture (25%)
- Cerebral contusion (10 - 40%)
- Thoracic Injury (36.8 %)
- Lung Injury (15 - 55%)
- Proximal Humerus Fracture (12%)
- Neurovascular Injury
- Brachial Plexus Injury (13%)[7])
- Axillary Nerve Injury
- Suprascapular Nerve Injury
- Great Vessel Injury (3.9 - 7%)
- Sternum Fracture
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Proximal Humerus Fracture
- Humeral Shaft Fracture
- Clavicle Fracture
- Scapula Fracture
- First Rib Fracture (traumatic or atraumatic)
- Dislocations & Separations
- Arthropathies
- Muscle & Tendon Injuries
- Rotator Cuff
- Bursopathies
- Ligament Injuries
- Neuropathies
- Other
- Pediatrics
- Coracoid Avulsion Fracture
- Humeral Head Epiphysiolysis (Little League Shoulder)
Clinical Features
- General: Physical Exam Shoulder
- History
- Patient will describe a history of trauma
- Complain of posterior back pain
- Physical
- Patient will often have tenderness over scapula
- Arm held in adduction with resisted abduction
- Given high risk for other pathology, be sure to exclude life threatening injuries
- Examine patient seated or standing to maximize evaluation of shoulder girdle
Evaluation
- Radiographs
- Standard Radiographs Shoulder including scapular Y and/or axillary
- Grashey view: better AP evaluation of scapula (also called AP Glenoid View)
- 50% involve body and spine of scapula (need citation)
- CT
- Standard imaging in suspected or confirmed scapular fractures
- Superior to Xray and useful to evaluate fracture pattern[8]
- Including intra-articular fracture, significant displacement
- three-dimensional reconstruction useful
- Note: Additional, appropriate imaging should be obtained in all patients for suspected associated injuries
Classification
- Based on location of fracture
Coracoid Fracture Classification
- Type I: Fracture proximal to the Coracoclavicular Ligament
- Type II: Fracture towards the tip of the coracoid
Acromial Fracture Classification
- Type I: Nondisplaced, minimally displaced
- Type II: Displaced, does not compromise the subacromial space
- Type III: Displaced, compromises the subacromial space
Ideberg Classification of Glenoid Fracture
- Type Ia: Anterior rim fracture
- Type Ib: Posterior rim fracture
- Type II: Fracture line through glenoid fossa exiting scapula laterally
- Type III: Fracture line through glenoid fossa exiting scapula superiorly
- Type IV: Fracture line through glenoid fossa exiting scapula medially
- Type Va: Combination of types II and IV
- Type Vb: Combination of types III and IV
- Type Vc: Combination of types II, III, and IV
- Type VI: Severe comminution
Management
Nonoperative
- Majority of scapula fractures
- Indications
- Minimal displacement
- Acceptable alignment
- Treatment
- Shoulder Sling for 2-4 weeks
- Early mobilization
- Dimitroulias et al: Satisfactory outcomes of 32 patients managed nonoperatively based upon final DASH score[9]
- Jones et al: similar outcomes between operative and nonoperative cases, despite the operative cohort having had significantly worse initial displacements[10]
Operative
- Indications
- Glenohumeral instability
- Excessive medialization of glenoid
- Displaced scapula neck fx
- Open
- Loss of rotator cuff function
- Coracoid fx with > 1cm of displacement
- Technique
- Open reduction, internal fixation
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- At discretion of surgeon
Complications
- Uncommon
- Nonunion (rare)
- Malunion
- Scapulothoracic Bursitis or pain
- Suprascapular Nerve Injury
See Also
- Internal
- External
- Sports Medicine Review Shoulder Pain: https://www.sportsmedreview.com/by-joint/shoulder/
References
- ↑ Court-Brown CM, Aitken SA, Forward DR, et al. The epidemiology of fractures. In: Bucholz RW, editor. Fractures in adults. Wilkins: Lippincott Williams; 2009.
- ↑ ROWE CR. Fractures of the scapula. Surg Clin North Am. 1963;43:1565–71.
- ↑ McClure PW, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther. 2006;86:1075–90.
- ↑ 4.0 4.1 Goss, Thomas P., and Marie E. Walcott. "Fractures of the scapula." Rockwood and Matsen's The Shoulder E-Book (2016): 243.
- ↑ Gottschalk HP, Dumont G, Khanani S, et al. Open clavicle fractures: patterns of trauma and associated injuries. J Orthop Trauma. 2012;26:107–9.
- ↑ Baldwin KD, Ohman-Strickland P, Mehta S, et al. Scapula fractures: a marker for concomitant injury? a retrospective review of data in the national trauma database. J Trauma. 2008;65:430–5.
- ↑ Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res. 1998;347:122–30.
- ↑ Anavian J, Conflitti JM, Khanna G, et al. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res. 2011;469:3371–8.
- ↑ Dimitroulias A, Molinero KG, Krenk DE, et al. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res. 2011;469:1459–65.
- ↑ Jones CB, Sietsema DL. Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures. Clin Orthop Relat Res. 2011.