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

Evaluation

X-ray showing a fracture of the scapula and clavicle.
A right sided scapula fracture with rib fractures underneath seen on a 3D reconstruction of a CT scan.
  • Dedicated scapular series (AP, lateral, axillary) will identify most fractures

Management

General Fracture Management

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

References