MANUAL MINORS
Scapular fractures are relatively rare injuries that occur due to high-energy trauma, such as car accidents or falls from height, as the scapula is protected by the muscles and rib cage. These fractures are often associated with other severe injuries, such as rib fractures, lung and thoracic injuries, or brachial plexus injuries. The fractures can affect the scapular body, spine, acromion, coracoid process, or glenoid cavity.
Diagnosis
Diagnosis is based on a history of severe trauma and clinical evaluation of intense pain in the back of the shoulder, swelling, and limited arm mobility. The patient may experience pain with deep breathing if concomitant rib fractures are present.
Anteroposterior and lateral shoulder X-rays are useful, but a computed tomography (CT) scan is often necessary to evaluate the extent of the fracture and possible displacements, especially if the glenoid cavity or joint is involved.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Clavicle fracture | Palpable deformity over the clavicle, common in falls onto the shoulder |
Glenohumeral dislocation | Intense pain with visible shoulder deformity and joint misalignment |
Humeral neck fracture | Shoulder pain after trauma, but with severely limited arm mobility |
Shoulder contusion | Localised pain without fracture on X-rays |
Brachial plexus injury | Pain and loss of sensation or strength in the arm, without bone fracture |
Emergency Management
Immediate emergency management focuses on pain control with analgesics and anti-inflammatory drugs, as well as stabilising the affected shoulder using a sling or neutral position bandage. Careful neurovascular assessment of the arm is essential, as scapular fractures may be associated with brachial plexus or blood vessel injuries.
Open, displaced fractures or those involving the glenoid cavity require urgent surgical evaluation. It is important to assess and treat any associated injuries, such as rib fractures or pneumothorax.
Definitive Treatment
Most non-displaced or minimally displaced scapular fractures are managed conservatively with immobilisation for 2 to 4 weeks, followed by physiotherapy to regain range of motion and strength.
Displaced fractures or those affecting the glenohumeral joint may require open reduction and internal fixation (ORIF) to restore joint congruence and prevent post-traumatic arthritis. Postoperative rehabilitation is essential to restore shoulder function and avoid stiffness or loss of mobility.
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