Scapular fracture

Background

Scapula anatomy.

Scapula anatomy.

• Occurs via direct trauma to shoulder area or FOOSH
  • Fractures of body and glenoid are most common
• >75% are associated with other injuries (ribs, lung, shoulder girdle)
• Association with thoracic aortic injury classically taught, but actually <1% association in clinical practice

Clinical Features

• Localized tenderness over scapula with ipsilateral arm held in adduction
• Any arm movement will worsen pain

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Evaluation

X-ray showing a fracture of the scapula and clavicle.

Sagittal reconstructed CT image showing multiple fractures of the left scapula.

A right sided scapula fracture with rib fractures underneath seen on a 3D reconstruction of a CT scan.

Workup

• CT chest with contrast (trauma protocol)

Diagnosis

• While a dedicated scapular series (AP, lateral, axillary) will identify most fractures, CT chest is typically indicated to exclude other injuries.

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• Rule-out other injuries
  • Low threshold for additional CT imaging or obs
• Sling, ice

Disposition

• Typically discussed with orthopedic specialist with in ED
• If no other injuries of significance, may be discharged home

Sub-Specialty Care

Indications for surgery:

• Glenohumeral instability
• Displaced scapular neck fracture
• Open fracture
• Loss of rotator cuff function
• Displaced coracoid fracture

See Also

• Fractures (Main)