Treatment includes pain management, shortterm use of a sling for comfort, and physical therapy as needed. The approach helps guide decision making on operative versus nonoperative treatment. 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. 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 shoulder blade has a ridge going along it known as the spine of the scapula. 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. Medical therapy for a patient with a scapula fracture generally is the same. Fractures of the scapula university of pennsylvania orthopaedic.
Ct scanning is necessary to define the degree of translational or angulatory displacement. 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. Pain, tenderness, swelling, bruising, or a bump in the injured area. Only about 10 percent of scapula fractures require surgery. However, these highenergy injuries are being seen more often likely because of improved emergency response and trauma resuscitation. Scapular fractures are often associated with other injuries.
Dec 05, 2018 as the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Nov 09, 2018 broken or fractured shoulder scapula blades are rarely broken. 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. 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. Shoulder dislocations can involve any of the three different.
The term scapula literally means skapulare to dig, because the greek anatomists who. May 01, 2020 medical therapy for a patient with a scapula fracture generally is the same as that for any trauma patient. Eleven clavicle fractures were displaced greater than 10 mm, and five scapular fractures were displaced greater than 5 mm. Most scapula fractures can be managed effectively with closed treatment. Operative management of displaced glenoid fossa fractures and scapular neck fractures displaced 10mm lead in a better functional outcome. Scapula fracture this information will guide you through the next 6 weeks of your rehabilitation. Better understanding of this injury has resulted in greater acceptance of surgical management of. Shoulder injuries from trauma scapula nonunion hope tbi. The angle of the bone causes a deformity in the limb. Dedicated scapular series ap, lateral, axillary will identify most.
Scapula fracture shoulder blade fracture physioadvisor. Fracture line exiting through both lateral and superior scapular margins. Fractures of the scapula acta chirurgiae orthopaedicae et. 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. The management of scapula fractures has evolved over recent years as new techniques and ap proaches have been promulgated. The latter define the first days of hospitalization in polytraumatized patients. Over the past 2 decades, several studies have documented poor results following nonoperative management of both intra and extraarticular displaced scapular fractures. While such mechanisms have been well described, little is.
Multiple studies have documented poor functional outcomes following nonoperative management of displaced scapular fractures. Direct trauma is usually the cause of most scapula fractures. Many of the scapular fractures do not require surgery and may be treated with restricted activity with or without a bandage. Fracture occurs proximal to the coracoclavicular ligament. Scapular fractures are not common and many are amenable to conservative management. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery.
Ninetyfive percent of fractures healed without incident. 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. When it does, it is an indication that the individual was subjected to. Monitor progress with grip, pinch strength testing, rom progression, function of wrist extensors and and tolerance for supination with light loads. Scapular fractures are predominantly acquired during highyenergy trauma and. Aug, 2018 scapular body fractures generally occur as a result of highenergy, direct trauma to the shoulder sustained in automobile accidents. 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. 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. 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. Scapular fracture aftercare instructions what you need to. Displaced but does not compromise the subacromial space. Men between the ages of 25 to 45 years most commonly break their shoulder blade.
While such mechanisms have been well described, little is known about scapular body fractures sustained during sporting activities. Pain, swelling and bruising are the most common symptoms. More recent research has shown that over 90% of scapular fractures are nondisplaced or. Frequency scapula fractures are relatively uncommon. This article outlines a diagnostic workup and treatment approach for the various types of scapular fractures.
Fractures of the scapula occur very infrequently in small animal patients. Thus, scapula fractures occur at rates approaching those of distal tibia and humerus fractures. Nonoperative management of a displaced cartilaginous avulsion. Treatment of the scapula fracture itself should be initiated during the phase of. Nonoperative management of a displaced cartilaginous. Rate of recovery and the prognosis from scapular fracture will depend on a number of factors. A scapular fracture is a fracture of the scapula, the shoulder blade. Abstractwith 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. Shoulder trauma fractures and dislocations orthoinfo aaos.
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. Scapular body fractures generally occur as a result of highenergy, direct trauma to the shoulder sustained in automobile accidents. A scapular fracture is a break in your shoulder blade scapula. Horizontal fracture involving scapular neck and body fracture runs below the spine of scapula type 5.
Use the information below to gain a better understanding of your injury and what can be done to maximise. 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. A metaanalysis of operative versus nonoperative treatment in 463 scapular neck fractures 71 the grading of function was assessed using the constant score. Nonoperative treatments include the use of a sling or shoulder immobilizer, ice and pain medications. At a mean followup of 28 months, the average rowe score was 95 and the mean constant score was 96. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Helfet, md at the orthopedic trauma service of hospital for special surgery for definitive management of his scapula fracture. In comminuted fractures involving the scapular body and the glenoid it is quite often sufficient just to anatomically restore the articular sur. Signs and symptoms of a broken shoulder blade include pain, swelling, and bruising around the fracture, inability to lift the arm. Shoulder trauma fractures and dislocations orthoinfo. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and.
Although formerly felt to be rare, scapula fractures have been shown to occur with a rate of 0. In certain cases, surgery to repair a broken scapula is necessary. The term scapula literally means skapulare to dig, because the greek anatomists who named it thought that the shoulder blade looked like a spade. Management of fracture healing phase realistic long term goals focus on advancement of the hep. Broken or fractured shoulder scapula blades are rarely broken. Scapula fractures are uncommon injuries, representing 3% of all shoulder fractures. Severity minor fractures do well with immobilization and physical therapy, while fractures that are. Clients should be encouraged to seek proper treatment with the more difficult fractures as success rates are high and complications low. Normally, the scapula is pretty well protected by a web of muscles and it is very rare that the. Scapula fracture shoulder blade fracture johns hopkins. The ota lately presented a new and comprehensive system for classification of the scapular 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.
A metaanalysis of operative versus nonoperative treatment. However, little agreement exists on indications for surgery, and there is no. Shoulder dislocations can involve any of the three different joints that make up the shoulder. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. Helfet, md at the orthopedic trauma service of hospital for special surgery. Surgical approach, technique, and timing are individualized based on fracture type and other patientrelated factors. Surgery may be required if a fracture displaces bones, forcing them out of their normal positions. Results from this study corroborate the use of nonoperative management for. As the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Monitor progress with grip, pinch strength testing, rom progression, function of wrist extensors and. Thus, scapula fractures occur at rates approaching those of.
Diagnosis of a scapular neck fracture is reliably made by plain films. Your collarbone, arm bones, lungs, or chest may also be affected. 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. Ab with the exception of displaced articular glenoid fractures, management of. A comparison of exposure between the classic and modified judet approaches to the scapula. 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. Indications for surgical treatment of glenoid fossa, scapular neck, and scapular body fractures are presented in detail. Two recent reports on the subject found the mean age of patients with scapular fractures to be 42 years30 and 35 years. Shoulder fractures most often involve the clavicle collarbone, proximal humerus top of the upper arm bone, or the scapula shoulder blade. 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. These ideberg type 1 fractures of the gle noid are the most typical scapular fracture pattern encountered after shoulder dislocation, with shoulder dislocations accounting. Shoulder immobilizers may have additional straps and cuffs for the arm, wrist, and fingers for. 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.
Approximately 50% of scapula fractures involve the body and spine. Most scapular fractures occur secondary to vehicular trauma. 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. The shoulder blade scapula is located in the upper back, and sits on top of the ribs.
Physical therapy and rehabilitation can improve the range of motion in the shoulder, but needs. Anterior shoulder dislocation is an additional mechanism associated with intraarticular fracture of the anterior glenoid 40 fig. The scapula, or shoulder blade, is the bone located in the back. Therefore, they are frequently associated with severe injuries to the chest and skull. The scapula is sturdy and located in a protected place, so it rarely breaks. Feb 03, 2020 a scapular fracture is a break in your shoulder blade scapula. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. Operative techniques in the management of scapular fractures. Fractures of the scapula, almost without exception, occur during highenergy trauma. With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion. Surgery for a scapular fracture may be recommended when. Requires trauma series views to demonstrate the fractures.
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. Perform fluid resuscitation, stabilize the cardiopulmonary system, and treat lifethreatening injuries prior to operative fixation of scapula fractures. Clavicle and scapular fractures intermountainphysician. Concurrent injuries to the chest rib fractures, contusions. J am acad orthop surg with the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of. 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. 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. 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. Harmer ls, phelps kd, crickard cv, sample km, andrews eb, hamid n, et al.
363 119 1401 817 421 433 808 165 783 461 909 1548 1144 1541 1386 858 493 1381 563 1315 955 1387 631 386 408 417 1436 593 491 1154 420 277 1375 1165 266 830 1162 1437 1016 362 1181 263 108