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Scapula Fracture

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Other Names

  • Shoulder Blade Fracture
  • Scapular Fracture

Background

  • This page describes all fractures to the Scapula

Epidemiology

  • Less than 1% of all fractures[1]
  • 2-3% of all fractures associated with the shoulder girdle[2]

Pathophysiology

  • Uncommon
  • Almost always associated with high energy trauma
  • Less commonly: avulsion, stress, fatigue fracture

Pathoanatomy

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


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
  • 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


See Also


References


  1. Court-Brown CM, Aitken SA, Forward DR, et al. The epidemiology of fractures. In: Bucholz RW, editor. Fractures in adults. Wilkins: Lippincott Williams; 2009.
  2. ROWE CR. Fractures of the scapula. Surg Clin North Am. 1963;43:1565–71.
  3. 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. 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.
  5. Gottschalk HP, Dumont G, Khanani S, et al. Open clavicle fractures: patterns of trauma and associated injuries. J Orthop Trauma. 2012;26:107–9.
  6. 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.
  7. 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.
  8. 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.
  9. Dimitroulias A, Molinero KG, Krenk DE, et al. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res. 2011;469:1459–65.
  10. Jones CB, Sietsema DL. Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures. Clin Orthop Relat Res. 2011.
Created by:
John Kiel on 4 July 2019 09:45:50
Authors:
Last edited:
13 November 2020 13:39:34
Categories:
Trauma | Shoulder | Fractures | Back | Acute