Scapular fracture

Scapular fracture


Refers to a fracture of the scapula, the shoulder blade.

An estimated 0.4–1% of bone fractures are scapular fractures.

The scapula is sturdy.

The scapula is protected from the front by the ribcage and chest, and from the back it is protected by muscles.

The ability of the scapula to move, and to dissipate force, and indicates a large amount of force is required to fracture it.

A scapula fracture suggests the patient experienced a significant amount of force and that chest trauma may be present.


High-speed vehicle accidents are the most common cause, including: car accidents, motorcycle crashes, or high speed bicycle crashes, and falls and blows to the scapula.

Signs and symptoms include pain, tenderness, and reduced motion of the affected area.

Symptoms can take a couple of days to appear.

Imaging X-rays are used to diagnose scapular fracture.

Injuries that accompany scapular fracture generally have a greater impact on the patient’s outcome.

Treatment involves pain control, immobilization and, later, physical therapy.

Clinical findings include: pain, tenderness, swelling, and crepitus, reduced ability to move the shoulder joint.

The force to fracture the scapula may be indirect but is more often direct.

The scapula can be fractured due to the blunt trauma of a vehicle collision.

Scapular fracture is present in about 1% of cases of blunt trauma and 3–5% of shoulder injuries.

About three quarters of fractures scapulars are caused by high-speed auto and motorcycle collisions.

Falls and direct blows to the shoulder area can also cause the fracture.

The mean age of people affected is 35–45 years.

Scapular fractures are associated with other injuries 80–90% of the time, including pulmonary contusions more than 50% of the time.

Less than 5% of injuries are isolated to the scapula

Associated injuries can be serious and potentially deadly,

Usually the associated injuries, rather than the scapular fracture, that have the greatest effect on the outcome.

The forces involved in scapular fracture can also cause tracheobronchial rupture.

Fractures of the scapular body are the type most likely to be accompanied by other injuries, with bony and soft tissue injuries accompany these fractures 80–95% of the time.

When the scapula is fractured, other injuries such as abdominal and chest trauma are automatically suspected.

Pneumothorax, clavicle fractures, and injuries to the blood vessels are among the most commonly associated injuries.

Crushing injuries and sports injuries can also fracture the scapula.

Scapular fracture can result from muscles pulling in different directions that can be due to seizures or electric shock.

It can result from cardiopulmonary resuscitation chest compressions.

Anatomically the scapula has a body, neck, and spine.

Any of these part can be fractured.

The scapular body or neck is injured in about 80% of cases.

Scapular fractures that occur in the scapular body may be vertical, horizontal, or comminuted.

Scapular neck fractures are usually parallel to the glenoid fossa.

Glenoid fossa fractures are usually small chips out of the bone.

Glenoid fossa fractures may be extensions of fractures occurring in the scapular neck.

Most fractures of the scapula can be seen on a chest X-ray.

The X-ray findings may be missed during examination of the film, as serious associated injuries may distract from the scapular injury.

The diagnosis is often delayed.

When it occurs by themselves; the death rate is not significantly increased.

If a scapular injury is suspected, more specific images of the scapular area can be taken, as much of the scapula is hidden by the ribs on standard chest X-rays.

Types of fracture:

I Fracture proximal to the coracoclavicular ligament

II Fracture distal to the coracoclavicular ligament

Acromion fractures :

I Non- or minimally-displaced

II Displaced but not affecting the subacromial space

III Displacement compromising the subacromial space

Glenoid fossa fractures

Initial treatment involves pain medication and immobilization, icing, followed by physical therapy.

Mobility exercises are begun within at least a week of the injury.

Fractures with little or no displacement heal without problems account for over 90% of scapular fractures and are best managed without surgery.

Fractures of the scapular body with displacement may heal with malunion, but even this may not interfere with movement of the affected shoulder.

Surgical reduction is required for fractures in the neck or glenoid; otherwise motion of the shoulder may be impaired.

Displaced fractures in the scapular processes or in the glenoid do interfere with movement in the affected shoulder if they are not realigned properly.

Multiple studies found that 80% of those with glenoid involvement are treated operatively, while only 52% of those with exclusive acromion and/or coracoid involvement, and 1% of those with exclusive scapular body involvement were treated operatively.

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