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Night Fight Aftermath

Scapular fractures are uncommon, estimated to be only one percent of all fractures. Fractures of the body account for more than half of scapular fractures. Other fractures are those of the neck, glenoid, acromion, and the coracoid. A fractured scapula requires significant force, which demands the consideration of deeper injuries such as pulmonary contusions, pneumothorax, brachial plexus, and vascular injuries. It is also prudent to widen the physical evaluation to include head and abdominal trauma because the full mechanism of injury isn't usually isolated just to the scapula.

Most scapular fractures are treated conservatively with a sling and early mobilization... Surgery tends…

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Featured

 Scapula Fractures

Scapula does not have any bony connection to the thorax and serves primarily for muscle attachments. Serves as origin for the deltoid muscle, providing leverage for the primary movements of the shoulder. Majority of scapular fractures managed non-operatively with sling for 2 weeks then early range of motion exercises.

 Scapular body fractures—should we be fixing more of these?

The scapula is an integral part of the superior shoulder suspensory mechanism, which attaches the upper extremity to the axial skeleton. Seventeen muscular attachments and insertions provide a robust platform from which glenohumeral motion occurs. The question of whether we should be fixing more scapular body fractures originates from the historical preference for nonoperative management of these fractures. Recently, there has been a renewed interest in operative management due to the recognition that scapular malunion can cause significant disability. While the treatment pendulum has shifted away from benign neglect, surgical indications remain controversial.

Articles of Interest

Clavicle and scapula (floating shoulder)

The term floating shoulder refers to when a clavicle fracture or AC separation is coupled with a fracture of the scapula. There are a few variation of the floating shoulder fracture pattern. Because conservative treatment may result in displacement (medialization) of the shoulder girdle, a floating shoulder is usually thought to represent an unstable injury pattern that requires operative stabilization .

Current challenges and controversies in the management of scapular fractures: a review

Fractures of the scapula are rare and usually associated with high-energy trauma. The unfavorable scapular anatomy, combined with the complexity of the approaches for fracture fixation, make the treatment challenging, even for experienced surgeons. Furthermore, the literature is controversial regarding surgical indications and rationale for treatment.

Fall down stairs

77 year old female complains of pain when she moves her left shoulder after falling down five stairs. What's the diagnosis, management, and other common associated injuries?

Radiopaedia

Scapula fractures are uncommon injuries, representing ~3% of all shoulder fractures.

Scapular fracture

Scapular fractures may be difficult to diagnose on conventional radiographs but are easily appreciated on chest CT. They are described as body, spine, acromion, coracoid, scapular neck, and glenoid fractures. Fragment displacement is usually minimal due to the supporting muscles and periosteum. Unless the glenoid fossa is involved, most scapular fractures are managed nonoperatively. Fractures that extend to the articular surface may require operative reconstruction.

Scapular Fractures After RSA – The Bane of Our Existence

The development of postoperative scapular spine or acromial base fractures remains a difficult problem to treat. With a reported incidence of 1-10% in the literature, there has been no consensus on the best treatment, and most authors report poor post-fracture functional outcomes.

Scapular Fractures in the Pan-scan Era

Scapular fractures have been traditionally taught to be associated with significant injuries and major morbidity. As we demonstrated with sternal fracture, pulmonary contusion, and rib fracture, increased chest computed tomography (CT) utilization and head-to-pelvis CT (pan-scan) protocols in blunt trauma evaluation, however, may diagnose minor, clinically irrelevant scapular fractures, possibly rendering previous teachings obsolete.

Scapular Fractures: What Radiologists Need to Know

Scapular fractures are uncommon, accounting for only 3–5% of shoulder girdle fractures and fewer than 1% of all fractures. High-energy trauma is the most common cause, and scapular fractures are frequently associated with other acute injuries, including rib fracture (53%), lung injury (47%), head injury (39%), spinal fracture (29%), and clavicle fracture (25%).