Simplifying fracture of the scapula. All information taken from authentic sources.

1. Fractures of Scapula
Dr. Ashiqur Rahman
Resident Orthopedics
Dhaka Medical college Hospital

2. Introduction
 Fractures of the scapula are often as a consequence of high-energy
trauma.
 Common causes include blunt trauma, crushing injuries, falls &
seizures.
 The attached long head of the triceps may drag the glenoid
downwards & laterally.
 The coracoid process may # across it’s base or be avulsed at the tip.
 Fracture of the acromion is due to direct force.
 Fracture of the glenoid is due to medially directed force.

4. Clinical featrues:
 The arm is held immobile & there may be severe brusing over the
scapula or the chest wall.
 Fracture of the body of the scapula often associated with severe
injuries to the chest wall, brachial plexus, spine, abdomen & head.
 Careful neurologic & vascular examinations are essential.

5. Treatment
A. Body fractures:
- Surgery is not usually necessary
- The pt. wears a sling for comfort
- From the start practices active exercise to shoulder, elbow &
fingers.

6. B. Isolated glenoid neck fractures:
- Second most common # of scapula.
- A CT scan usually required to confirm it is extra-articular.
- The # is often displaced, but further displacement is
uncommon as long as clavicle is not fractured.
- The # frequently impacted & the glenoid surface intact.

7. C. Intra-articular fracture:
 Type I glenoid fractures, if displaced, may result in instability of the
shoulder.
 If the fragment involves more than a quarter of the glenoid surface
and is displaced by more than 5 mm, surgical fixation should be
considered.
 Anterior rim fractures are approached through a delto-pectoral
incision.
 And posterior rim fractures through the posterior approach.

8.  Type II fractures are associated with inferior subluxation of the head
of the humerus and require open reduction and internal fixation.
 Type III, IV, V and VI fractures have poorly defined indications for
surgery, but indications include excessive medialization of the glenoid
or intra-articular steps of more than 5 mm.
 Generally speaking, if the head is centred on the major portion of the
glenoid and the shoulder is stable, a non-operative approach is
adopted.
• Comminuted fractures of the glenoid fossa are likely to lead to
osteoarthritis in the longer term.

9. D.Fractures of the acromion:
• Undisplaced fractures are treated non-operatively.
• Only type III acromial fractures, in which the subacromial space is
reduced, require operative intervention to restore the anatomy.

10. D. Fractures of the coracoid process:
 Fractures distal to the coracoacromial
ligaments do not result in serious
anatomical displacement; those
proximal to the ligaments are usually
associated with acromioclavicular
separations and may need operative
treatment.

11. E. Combined fractures:
• Whereas an isolated fracture of the glenoid neck is stable, if there is
an associated fracture of the clavicle or disruption of the
acromioclavicular ligament, the glenoid mass may become markedly
displaced, giving rise to a ‘floating shoulder’.
• Diagnosis can be difficult and may require advanced imaging and 3D
reconstructions.
• At least one of the injuries (and sometimes both) will need operative
fixation before the fragments are stabilized.