A 26-year-old male presents to the ED after a 4-wheeler accident complaining of pain in his right upper chest, back, and shoulder. On exam, he refuses to abduct his right arm. The document discusses scapular fractures, noting that body fractures are most common but the acromion and glenoid should also be examined. Treatment depends on the specific location of the fracture, with slings and PT for body fractures and possible surgery for neck or glenoid fractures. Prognosis is generally good for isolated body fractures but worse for neck or glenoid fractures.

2.  A 26yo male comes walks into your ED after a 4-
wheeler accident. On exam, he holds his arm close
to his body and refuse to let you abduct his arm. He
says his right upper chest, upper back, and
shoulder all hurt. Exam is otherwise normal.

4.  Identification of a fracture lucency can be difficult
 Fracture of the body most common, but don’t forget to
carefully examine the acromion and glenoid
 Consider adding scapular Y view if clinical concern
 Necessary for two-plane evaluation of scapula

5.  Body of scapula
 Immobilization with a sling
 Physical therapy as early as one week after injury
 Neck or glenoid involvement of scapular fracture
 Surgical reduction
 Prognosis
 Isolated scapular body fracture have excellent prognosis
 Fractures of scapular neck and scapular glenoid more
likely to have complications such as impaired strength and
ROM, as well as early arthritis

6.  Because of the unique anatomy of scapular there are a
variety of mechanisms of injury causing fractures but
are generally the result of large, blunt forces
 Associated injuries seen in 80-90% of pts, warranting a
close exam and likely trauma imaging
 Essential to rule out articular involvement with a high-
quality AP shoulder film with no overlap of the
humerus over the glenoid

9.  Marx J MD; Hockberger R MD; Walls R MD. Rosen’s
emergency medicine. 7th ed.
 Simon R; Sherman S; Koenigsknecht S. Emergency
orthopedics: the extremities. 5th ed. McGraw Hill
Publishing.
 Wheeless C R III MD. Wheeless textbook of
orthopedics. www.wheelessonline.com.