Fractures of the scapula

Abstract

The scapula plays a critical role in the association between the upper extremity and the axial skeleton. Fractures of the scapula account for 0.4% to 1% of all fractures and have an annual incidence of approximately 10 per 100,000 inhabitants. Scapular fractures typically result from a high-energy blunt-force mechanism and are often associated with other traumatic injuries. The present review focuses on the presentation, diagnosis, and treatment of fractures of the scapula. Indications for surgical treatment of glenoid fossa, scapular neck, and scapular body fractures are presented in detail. Finally, the authors' preferred surgical technique, including positioning, approach, reduction, fixation, and post-operative management, is described.

Figures

Figure 1

Anteroposterior chest radiograph demonstrating a left scapular fracture.

Figure 2

Anteroposterior (a) and lateral (b) radiographs of the left shoulder demonstrating a comminuted fracture of the lateral aspect of the left scapula with glenoid involvement.

Figure 3

Axial (a–c), coronal (d–f), and saggital (g–i) cuts of the left shoulder CT scan demonstrating a displaced, comminuted scapular fracture that originates at the base of the coracoid process and extends into the posterior glenoid and into the midbody of the scapula.

Figure 4

Three-dimensional reconstructions of the left shoulder CT scan.

Figure 5

The patient is positioned in lateral decubitus on a beanbag with the operative arm in the prone position.

Figure 6

The curvilinear incision is positioned along the medial border of the scapula and the scapular spine.

Figure 7

A full-thickness flap overlying the deltoid fascia is created, thereby exposing the posterior deltoid.

Figure 8

The deltoid origin is sharply released from the scapular spine, and the deltoid is retracted laterally.

Figure 9

The interval between the infraspinatus and teres minor is developed with meticulous care taken to avoid the axillary nerve and the innervation to the infraspinatus. The scapular fracture is exposed within this interval.

Figure 10

Intraoperative photographs demonstrating the scapular fracture before (a) and after (b) reduction using a 4 mm Shantz pin and two point-to-point clamps.

Figure 11

Intraoperative photograph demonstrating three small fragment plates positioned to maintain reduction of the scapular fracture.

Figure 12

Postoperative anteroposterior radiograph of the left shoulder demonstrating an anatomic reduction of the scapular fracture with good positioning of the implants.