Updated: 12/4/2018

Scapula Fracture

Review Topic
  • A 30-year-old man presents to the emergency room after a motor vehicle accident. Upon arrival, he has difficulty breathing and reports shoulder pain. On physical exam, he has decreased breath sounds on the right side and significant tenderness of his right shoulder. There is overlying ecchymosis, swelling, and erythema over his right scapula and limited range of motion.  
  • Clinical definition
    • fracture of the scapula that is often associated with high energy or high force trauma
  • Epidemiology
    • incidence
      • uncommon only < 1% of all fractured bones
    • demographics
      • male > female
      • more common in males < 50 and females > 64 years of age
  • Pathogenesis
    • most commonly due to blunt force trauma to the scapula
      • fall
      • motor vehicle accident
  • Associated conditions
    • associated injuries from trauma
      • lung injury including pneumothorax or hemothorax
      • head injury
      • spinal injury
  • Prognosis
    • very good if without any associated injuries
  • Symptoms
    • shoulder pain that worsens with movement
    • limited mobility of the shoulder
  • Physical exam
    • focal swelling, deformity, and bruising around the scapula
    • decreased range of motion of the shoulder
    • must conduct thorough neurovascular exam
  • Radiographs
    • indication
      • for all patients
    • recommend views
      • anteroposterior, lateral axillary, and scapular views
    • findings
      • fracture of the scapula
  • Clavicle fracture
    • distinguishing factor
      • fracture of clavicle on imaging
      • intact scapula on imaging
  • Management approach
    • most cases do not require surgical repair
  • Conservative
    • immobilization for 2 weeks and subsequent physical therapy
      • indication
        • for patients with isolated and stable scapula fracture
      • modalities
        • sling
  • Medical
    • nonsteroidal anti-inflammatory drugs
      • indication
        • pain management
  • Operative
    • surgical treatment
      • indications
        • displaced or unstable fracture
        • associated triceps impairment
        • open fractures
      • surgery
        • open reduction internal fixation
  • Malunion
  • Arthritis
  • Adhesive capsulitis

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