Snapshot 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. Introduction 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 Presentation 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 Studies Radiographs indication for all patients recommend views anteroposterior, lateral axillary, and scapular views findings fracture of the scapula Differential Clavicle fracture distinguishing factor fracture of clavicle on imaging intact scapula on imaging Treatment 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 Complications Malunion Arthritis Adhesive capsulitis