Helfet, md at the orthopedic trauma service of hospital for special surgery. Shoulder fractures most often involve the clavicle collarbone, proximal humerus top of the upper arm bone, or the scapula shoulder blade. A metaanalysis of operative versus nonoperative treatment. Nonoperative management of a displaced cartilaginous. Abstract with the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as allowed by the patients pain. The management of scapula fractures has evolved over recent years as new techniques and ap proaches have been promulgated. Anterior shoulder dislocation is an additional mechanism associated with intraarticular fracture of the anterior glenoid 40 fig. While such mechanisms have been well described, little is known about scapular body fractures sustained during sporting activities. Operative management of displaced glenoid fossa fractures and scapular neck fractures displaced 10mm lead in a better functional outcome.
Displaced but does not compromise the subacromial space. As the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. A scapular fracture is a break in your shoulder blade scapula. Broken or fractured shoulder scapula blades are rarely broken. Diagnosis of a scapular neck fracture is reliably made by plain films. Shoulder dislocations can involve any of the three different. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. Multiple studies have documented poor functional outcomes following nonoperative management of displaced scapular fractures. However, these highenergy injuries are being seen more often likely because of improved emergency response and trauma resuscitation. Ninetyfive percent of fractures healed without incident. Therefore, they are frequently associated with severe injuries to the chest and skull. Harmer ls, phelps kd, crickard cv, sample km, andrews eb, hamid n, et al. Thus, scapula fractures occur at rates approaching those of.
Scapular fractures are not common and many are amenable to conservative management. Shoulder immobilizers may have additional straps and cuffs for the arm, wrist, and fingers for. Scapula fracture shoulder blade fracture johns hopkins. Scapular fractures are predominantly acquired during highyenergy trauma and. Shoulder dislocations can involve any of the three different joints that make up the shoulder. Management a fracture of the glenoid fossa with an articular stepoff of 5 mm or more must be considered for surgical intervention to restore articular congruity and that displacement of 10. Feb 03, 2020 a scapular fracture is a break in your shoulder blade scapula. Scapular fracture aftercare instructions what you need to. It is estimated that scapula fractures account for 3 %5 % of all fractures about the shoulder girdle, with the most frequent fractures encountered occurring in the. The scapula is a flat and triangular bone, with a thin translucent body, surrounded by borders that are well developed because of their positions as muscular origins and insertions. Fracture patterns anatomic neck exits lateral to coracoid, surgical neck exits medial to coracoid watch out for fractures through inferior glenoid neck that runs along or through inferior border of. Two recent reports on the subject found the mean age of patients with scapular fractures to be 42 years30 and 35 years. The ota lately presented a new and comprehensive system for classification of the scapular fractures. A scapula fracture usually occurs due to a direct blow to the shoulder blade, such as a motor vehicle accident, a hard ball impact in sports such as cricket or hockey, or a heavy.
These ideberg type 1 fractures of the gle noid are the most typical scapular fracture pattern encountered after shoulder dislocation, with shoulder dislocations accounting. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. More recent research has shown that over 90% of scapular fractures are nondisplaced or. The shoulder blade has a ridge going along it known as the spine of the scapula.
Management of fracture healing phase realistic long term goals focus on advancement of the hep. Rate of recovery and the prognosis from scapular fracture will depend on a number of factors. Nonoperative management of a displaced cartilaginous avulsion. This article outlines a diagnostic workup and treatment approach for the various types of scapular fractures.
Nonoperative treatments include the use of a sling or shoulder immobilizer, ice and pain medications. Signs and symptoms of a broken shoulder blade include pain, swelling, and bruising around the fracture, inability to lift the arm. Although formerly felt to be rare, scapula fractures have been shown to occur with a rate of 0. At a mean followup of 28 months, the average rowe score was 95 and the mean constant score was 96. Monitor progress with grip, pinch strength testing, rom progression, function of wrist extensors and. Monitor progress with grip, pinch strength testing, rom progression, function of wrist extensors and and tolerance for supination with light loads. Normally, the scapula is pretty well protected by a web of muscles and it is very rare that the scapula sustains a fracture, but if there is a scapula fracture then it gives an indication that the shoulder must have been injured with a significant amount of force coupled with significant trauma to the chest. Treatment includes pain management, shortterm use of a sling for comfort, and physical therapy as needed. Fracture occurs proximal to the coracoclavicular ligament. A scapular fracture is a fracture of the scapula, the shoulder blade. Concurrent injuries to the chest rib fractures, contusions. Clients should be encouraged to seek proper treatment with the more difficult fractures as success rates are high and complications low. Using a sling or shoulder immobilizer to prevent movement. Use the information below to gain a better understanding of your injury and what can be done to maximise.
Treatment of the scapula fracture itself should be initiated during the phase of. The latter define the first days of hospitalization in polytraumatized patients. Many of the scapular fractures do not require surgery and may be treated with restricted activity with or without a bandage. Most scapula fractures can be managed effectively with closed treatment. The prognosis following scapular body fracture repair is generally excellent, the prognosis for scapular neck fractures is good to excellent, while the prognosis for articular fractures may be.
Jan 23, 20 over the past decade, there has been an increased interest in understanding the operative indications and techniques in treating scapular fractures and tracking their outcomes. Scapular fractures are often associated with other injuries. Fractures of the scapula acta chirurgiae orthopaedicae et. Horizontal fracture involving scapular neck and body fracture runs below the spine of scapula type 5. When it does, it is an indication that the individual was subjected to a considerable amount of force and that severe chest trauma may be present. In total, there were 120 patients with scapular body fractures, 95 with scapular neck fractures, with floating shoulder injuries including a scapular neck or body fracture, and 324 with an. Surgical approach, technique, and timing are individualized based on fracture type and other patientrelated factors. Over the past 2 decades, several studies have documented poor results following nonoperative management of both intra and extraarticular displaced scapular fractures. Frequency scapula fractures are relatively uncommon. Severity minor fractures do well with immobilization and physical therapy, while fractures that are. With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion.
Only about 10 percent of scapula fractures require surgery. Scapula fracture this information will guide you through the next 6 weeks of your rehabilitation. May 30, 2017 the prognosis following scapular body fracture repair is generally excellent, the prognosis for scapular neck fractures is good to excellent, while the prognosis for articular fractures may be poorer, with the majority of dogs regaining function but with a persistent lameness associated. Operative management is generally reserved for glenoid fracturedislocation, unstable fracture of the scapular neck, and significantly displaced apophyseal fracture, for which nonunion, malunion, and late. The term scapula literally means skapulare to dig, because the greek anatomists who named it thought that the shoulder blade looked like a spade. Ab with the exception of displaced articular glenoid fractures, management of.
Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and. Shoulder trauma fractures and dislocations orthoinfo aaos. Pain, tenderness, swelling, bruising, or a bump in the injured area. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. When it does, it is an indication that the individual was subjected to. Operative management is generally reserved for glenoid fracture dislocation, unstable fracture of the scapular neck, and significantly displaced apophyseal fracture, for which nonunion, malunion, and late disability are reported with conservative management 10, 23. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery.
A comparison of exposure between the classic and modified judet approaches to the scapula. Signs and symptoms of a broken shoulder blade include pain, swelling, and bruising around the fracture, inability to lift the arm, and pain when inhaling. Eleven clavicle fractures were displaced greater than 10 mm, and five scapular fractures were displaced greater than 5 mm. The shoulder blade scapula is located in the upper back, and sits on top of the ribs. Shoulder trauma fractures and dislocations orthoinfo. In addition, a fracture of the scapular spine may cause rotator cuff dysfunction because the entire scapula collapses with hortening, with resultant shortening of the rotator cuff lever arm. Other major injuries often accompany scapular fractures, such as fractures in the shoulder, collarbone and ribs, or damage to the head, lungs, or spinal cord. Dedicated scapular series ap, lateral, axillary will identify most.
Surgery for a scapular fracture may be recommended when. Normally, the scapula is pretty well protected by a web of muscles and it is very rare that the. Scapula fracture shoulder blade fracture physioadvisor. Ct, fracture, radiography, scapula, shoulder, trauma. A metaanalysis of operative versus nonoperative treatment in 463 scapular neck fractures 71 the grading of function was assessed using the constant score. May 01, 2020 medical therapy for a patient with a scapula fracture generally is the same as that for any trauma patient.
With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as allowed by the patients pain. Knowledge of scapular anatomy, function, injury patterns, imaging appearance, and clinical management is important for the radiologist to the care of patients who present with acute shoulder trauma. Medical therapy for a patient with a scapula fracture generally is the same. Scapular fracture aftercare instructions what you need. Open reduction and internal fixation orif for the clavicle fracture was performed at the outside hospital using a plate placed on the superior aspect of the clavicle. Ab with the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as allowed by the patients pain. Aug, 2018 scapular body fractures generally occur as a result of highenergy, direct trauma to the shoulder sustained in automobile accidents. Surgery may be required if a fracture displaces bones, forcing them out of their normal positions. Nov 09, 2018 broken or fractured shoulder scapula blades are rarely broken.
The scapula, or shoulder blade, is the bone located in the back. Dec 05, 2018 as the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Fractures of the scapula, almost without exception, occur during highenergy trauma. The angle of the bone causes a deformity in the limb. Clavicle and scapular fractures intermountainphysician. Direct trauma is usually the cause of most scapula fractures. While such mechanisms have been well described, little is. Helfet, md at the orthopedic trauma service of hospital for special surgery for definitive management of his scapula fracture. Pain, swelling and bruising are the most common symptoms. Better understanding of this injury has resulted in greater acceptance of surgical management of. Scapular body fractures generally occur as a result of highenergy, direct trauma to the shoulder sustained in automobile accidents. The scapula is sturdy and located in a protected place, so it rarely breaks. Requires trauma series views to demonstrate the fractures. Concurrent injuries to the chest rib fractures, contusions, pneumothorax or peripheral nerves or nerve roots are commonly observed, so careful evaluation of the patient, including chest radiographs and neurological examination, is important.
Perform fluid resuscitation, stabilize the cardiopulmonary system, and treat lifethreatening injuries prior to operative fixation of scapula fractures. Approximately 50% of scapula fractures involve the body and spine. Scapula fractures are uncommon injuries, representing 3% of all shoulder fractures. Highenergy, blunt trauma injuries, such as those experienced in a motorcycle or motor vehicle collision or falling from a significant height, can cause a scapula fracture. Indications for surgical treatment of glenoid fossa, scapular neck, and scapular body fractures are presented in detail. In certain cases, surgery to repair a broken scapula is necessary. Shoulder injuries from trauma scapula nonunion hope tbi. The term scapula literally means skapulare to dig, because the greek anatomists who. However, little agreement exists on indications for surgery, and there is no. Ct scanning is necessary to define the degree of translational or angulatory displacement. Your collarbone, arm bones, lungs, or chest may also be affected.
Men between the ages of 25 to 45 years most commonly break their shoulder blade. J am acad orthop surg with the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of. Results from this study corroborate the use of nonoperative management for. In comminuted fractures involving the scapular body and the glenoid it is quite often sufficient just to anatomically restore the articular sur. As more focus is placed on the proper management of scapular injuries, functional outcomes should improve. Most scapular fractures occur secondary to vehicular trauma. Fractures of the scapula university of pennsylvania orthopaedic. The approach helps guide decision making on operative versus nonoperative treatment. Operative techniques in the management of scapular fractures. Fracture line exiting through both lateral and superior scapular margins.
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