This presentation accompanied a talk given by Melbourne based Orthopaedic Surgeon Mr Ash Moaveni, FRACS, on scapula fractures. http://www.melbourneshoulder.com.au - Epidemiology - Clinical Evaluation - Imaging - Classification of Fractures - The Evidence - Non-Operative Management - Operative Indications - Operative Approach - Summary

1. Scapula Fractures
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

2. I declare that in the past three years:
• held shares in : Nil
• received royalties from: Nil
• done consulting work for: Nil
• given paid presentation for: Nil
• received institutional support from: Nil
• Signed: Ash Moaveni
Declaration of Interest

3. Epidemiology
• 3-5% of shoulder injuries
• High energy injury
• 90% of patients will have
associated injuries

4. Clinical Evaluation
• ABCs
• Secondary Survey
• Inspection of Skin
• Neurology

5. Imaging
• Trauma Series XRs
• CT scan
• Including 3D recons

6. Classification of Fractures
• Ideberg - Fractures of the
scapula involving the glenoid
fossa
• Acta Orthop Scand 1995
• AO/OTA – Fractures of the
scapula
• Focus on glenoid fossa
• Focus on body
• JSES 2013/2014

7. Classification of Fractures
- Ideberg I
• Type I: Avulsion fracture of
anterior glenoid margin
Ideberg R. Fractures of
the scapula involving the
glenoid fossa. The
surgery of the shoulder.

8. Classification of Fractures
- Ideberg II
• Type II: Transverse or
oblique fracture through
glenoid fossa, exiting
inferiorly.
Ideberg R. Fractures of
the scapula involving the
glenoid fossa. The
surgery of the shoulder.

9. Classification of Fractures
- Ideberg III
• Type III: Oblique fracture
through the glenoid exiting
superiorly (+/- AC joint injury)
Ideberg R. Fractures of the
scapula involving the glenoid
fossa. The surgery of the
shoulder.

10. Classification of Fractures
- Ideberg IV
• Type IV: Transverse fracture
exiting medial border of
scapula
Ideberg R. Fractures of
the scapula involving the
glenoid fossa. The
surgery of the shoulder.

11. Classification of Fractures
- Ideberg V
• Type V: Combination of II
and IV injuries
Ideberg R. Fractures of
the scapula involving the
glenoid fossa. The
surgery of the shoulder.

12. Classification of Fractures
- AO/OTA
• Glenoid Fossa

13. Classification of Fractures
- AO/OTA
• Body Involvement

14. The Evidence
• Systematic Review (2006)
• Glenoid Involvement
• Operative 80%
• Good/Excellent Result 82%
• Isolated scapula body
• Non Operative 99%
• Good/Excellent Result 86%
• Scapula Neck
• Non Operative 83%
• Good/Excellent Result 77%

15. The Evidence
• Systematic Review (2006)
• Scapula Neck and Ipsilateral
Clavicle
• Non Operative 94% with good
or excellent results

16. Non-Operative Management
• Sling 2-3 weeks
• Serial XRs to document
stability/displacement
• Range of motion at 4
weeks
• Loading/Strengthening at
8-10 weeks

17. Operative Indications
• Isolated Process/Scapula
Spine Fractures
• Intra-articular Glenoid
Fractures
• Extra-articular Glenoid
Fractures

18. Operative Indications
• Isolated Process/Scapula
Spine Fractures
• Displacement of > 1 cm
• Painful non union
• Double disruption of Superior
Shoulder Suspensory Complex
• +/- Concomitant ipsilateral
operative scapula fracture
requiring surgery

19. Operative Indications
• Intra-articular Glenoid
Fractures
OpenArthroscopic
Non operative

20. Operative Indications
• Extra-articular Scapula
Fractures
• Shortening >25 mm
• Angular Deformity > 45
degrees
• Intra-articular step off > 3mm
• Floating Shoulder

21. Operative Indications
• Extra-articular Scapula
Fractures
• Shortening >25 mm
• Angular Deformity > 45
degrees
• Intra-articular step off > 3mm
• Floating Shoulder

22. Operative Approach
• Posterior Approach to the
Shoulder/Scapula

23. Operative Approach
Obremskey, et. al, JOT 2004.
Harmer, et al, JOT 2016

24. Operative Approach
Superficial Layer
- Deltoid and Lat Dorsi

25. Operative Approach
Deep Layer
- Teres Minor and Infraspinatus

26. • Majority of scapula fractures are managed non-
operatively.
• Anterior glenoid rim fractures, scapula fractures with
significant displacement and “floating shoulders” may
benefit from operative fixation.
• Familiarity with anterior and posterior approaches to the
scapula allows fixation of most fractures.
Ash Moaveni, Melbourne
ash@moaveni.com.au
In Summary