Scapular fractures

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Scapular fractures
Puneet Monga
Consultant Orthopaedic Shoulder Surgeon

2. Structure
Image courtesy- Google Images

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Mechanism
Commonly associated with Chest, spine, clavicle,
abdominal and pelvic injuries

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Classification
A Fractures of the body of scapula
B. fractures of the process
B1 spine
B2 coracoid
B3 acromion
C Fractures of scapular neck
C1 anatomical neck
C2 surgical neck
C3 surgical neck with
D. Articular fractures
D1 glenoid rim
D2 glenoid fossa with
a. inferior glenoid fragment
b. horizontal split of scapula
c. coracoglenoid block formation
d. comminuted fractures
D3 scapula neck and body fracture
E. Fracture combination with humeral head fractures Euler and Rüedi

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Classification
Ideberg

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The floating shoulder
Superior shoulder suspensory complex

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Management
Guidelines
A Fractures of the body of scapula
Euler and Rüedi
Risk of malunion - rib friction
Risk of non union

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Management
Guidelines
B. fractures of the process
B1 spine
B2 coracoid
B3 acromion
Euler and Rüedi
Displaced?
Will it Heal

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Management
Guidelines
C Fractures of scapular neck
C1 anatomical neck
C2 surgical neck
C3 surgical neck with
Euler and Rüedi
Shortening?
Loss of RC length /tension

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Management
Guidelines
D. Articular fractures
D1 glenoid rim
D2 glenoid fossa with
a. inferior glenoid fragment
b. horizontal split of scapula
c. coracoglenoid block formation
d. comminuted fractures
D3 scapula neck and body fracture
Euler and Rüedi
Articular surface disruption?
Instability?

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Management
Guidelines
E. Fracture combination with humeral head fractures
Euler and Rüedi
Is the SSSC disputed?

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Surgical Approach

13. Posterior Approach

14. Pre-contoured Plates

15. Case 1

16. MR

17. Arthroscopic repair

18. Case 2

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Challenges
• Raising Awareness for early diagnosis and referral
• Management of associated injuries
• Look for stability of the anterior and posterior “strut”