The scapula is a bone that sits congruently against the ribs and stabilizes the upper extremity against the thorax.

It links the upper extremity to the axial skeleton through the glenoid, the acromioclavicular joint, clavicle, and the sternoclavicular joint.

Fracture of the scapula is not that common. The low incidence of scapular fractures has been attributed to thickened edges, great mobility with recoil, and its layers of muscle around it. The fractures generally occur in young patients.

Mechanisms of Injury

• Indirect injury
  This occurs when load is transmitted axially through the arm  on the outstretched arm
• Direct Injury
  Direct trauma from a blow or fall  may cause a fracture.
• Traction Injuries
  Pull by muscles or ligaments may cause avulsion fractures.

Presentation

Usual history is of motor vehicle accidents which led to fall. There is a complaint of pain in shoulder region and movements of arm are painful. Selling and bruises may be evident.

Associated injuries to other points in the shoulder girdle, the thoracic cage, and soft tissues are common. Often the physician may miss the scapular fractures due to associated and more ovbious injuries.

Radiographic Findings

Because of its complex anatomy and superimposition of the thorax and other structures, scapular fractures may be difficult to visualize.Therefore, multiple viewsin different planes may be required to adequately evaluate them.

Following views are helpful

• A true anteroposterior view of the scapula a
• True scapular lateral view
• The axillary lateral view

CT

Computed tomographic scan is important in evaluating a glenoid or coracoid fractures. CT reconstruction in helps to assess displacement of glenoid intraarticular fractures.

Types of Scapular Fractures

For ease of classification and discussion, scapular fractures are broadly classified based on their anatomical location

• I – The coracoid and acromion
• II-The glenoid and neck
• III – Scapular body fractures.

Coracoid and Acromion Fractures

Acromial Fractures

• Type I are minimally displaced and can be treated nonoperatively.
• Type II fractures are displaced but do not cause reduction in the subacromial space. Can be treated non operatively.
• Displaced type III fractures with reduction of the subacromial space. These fractures would need surgical intervention

Coracoid Fractures

• Proximal to coracoclavicular ligaments
• Distal to the coracoclavicular ligaments

Former type is more sever and may require surgical fixation.

The Glenoid and Neck

Extraarticular Glenoid neck Fractures

DocumentFurtherclassified as being with or without an associated acromioclavicular separation or clavicular fracture

Intrarticular Glenoid Neck Fractures

They are further classified into six subtypes

• Type I, fractures of the glenoid rim;
  • type IA, Anterior rim fracture;
  • type IB, Posterior rim fracture

• Type II – Fracture line through the glenoid fossa exiting at the lateral border of the scapula
• Type III – Fracture line through the glenoid fossa exiting at the superior border of the scapula
• Type IV – Fracture line through the glenoid fossa exiting at the medial border of the scapula
• Type IV fracture in combinaion with other fracture patterns
  • 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 – Comminuted fracture

Treatment

Mmost of the scapular fractures can be treated non operatively. Results have in general been satisfactory with conservative treatment. A sling support for 3-4 weeks and early rehabilitation is the key to successful non operative treatment.

However few might require surgical treatment.

Intraarticular Glenoid Fractures

These fractures may require surgical treatment due to intrarticular nature and high chances of arthritis developing with conservative treatment.

Acromial Fractures
A nondisplaced fracture of the acromion should respond well to conservative treatment. Displaced fractures require reduction and fixation with tension-band wires or screws.
Coracoid Fractures

For isolated coracoid fracture no specific treatment is needed. A sling to support would surfice.  For the coracoid fracture with acromioclavicular separation, surgical and nonsurgical treatment can be equally be used depending on the individual demands.

Scapular Body Fractures

Nonoperative treatment yields good results

Extraarticular glenoid neck fractures

Sling immobilization is enough. Reduction of the fracture is not necessary. Mobilisation should begin early

Popularity: 8% [?]

Related posts:

1. Conditions That Could Be Mistaken As Scapular Fractures
2. Proximal Humerus Fractures – Displaced Fractures of Tuberosity
3. Fractures of Proximal Humerus
4. Xray of Fracture Of Scapula
5. Fractures of The Clavicle-Part II

Tags: acromial fractures, acromion fractures, coracoid fractures, fracture of scapula, glenoid fractures, scapular fracture classification, treatment of scapular fractures