More recent research has shown that over 90% of scapular fractures are nondisplaced or. The term scapula literally means skapulare to dig, because the greek anatomists who named it thought that the shoulder blade looked like a spade. Highenergy, blunt trauma injuries, such as those experienced in a motorcycle or motor vehicle collision or falling from a significant height, can. We help you diagnose your scapula case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Fracture of the body, neck, or spine of the scapula. This normally takes between 612 weeks to unite heal. Two recent reports on the subject found the mean age of patients with scapular fractures to be 42 years30 and 35 years. Indications for surgical treatment of glenoid fossa, scapular neck, and scapular body fractures are presented in detail. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. Scapula fractures are frequently the result of highenergy trauma thus there should always be concern for associated injuries and a complete physical exam should be performed. The chest wall could be involved in a scapular fracture, since it protects the shoulder blade.
Scapula shoulder blade fracture management in the emergency. Scapula fracture injuries and treatment william t obremskey md mph peter cole md paul tornetta md cliff jones md slide 2 w t ill y es t t l a 15 s. Open fx management adult knee trauma radiographic evaluation gustilo classification. Requires trauma series views to demonstrate the fractures due to the superimposition of the shoulder girdle and thoracic cage. 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.
Dec 10, 2015 scapula fractures of the neck or body are rare. Debridement of open fractures can be repeatedstaged o continue to report with 1101011012 until definitive management of the fracture performed o attach 58 modifier o once fracture has been treated and treatment is directed at management of the wound report wound management codes can be reported multiple times on same claim if different. However, 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 and other parts of the body as well. Rehabilitation programs for operative and nonoperative. Scapula fractures in complex shoulder injuries and floating shoulders. May 01, 2020 most scapula fractures can be managed with closed treatment.
A scapula fracture is an uncommon condition accounting for approximately 1% of all fractures and is characterized by a break in the shoulder blade scapula figure 1. More than 90% of scapula fractures have minimal displacement, primarily because of the thick, strong support provided by the surrounding soft tissues. With the development of modern techniques in both surgical approach and internal fixation, surgeons began fixing selected scapula fractures utilizing arbeitsgemeinschaft fur osteosynthesefragen ao principles of restoration of articular surface, alignment, and stable internal fixation leading to a renewed interest in the operative management of both displaced intraarticular and extraarticular scapular fractures. For scapula fractures that are intraarticular, markedly displaced, or associated with other injuries to the shoulder. Only about 10 percent of scapula fractures require surgery. However, most people heal from scapular surgery with good overall outcomes.
In comminuted fractures involving the scapular body and the glenoid it is quite often sufficient just to anatomically restore the articular sur. Ct, fracture, radiography, scapula, shoulder, trauma. The shoulder blade has a ridge going along it known as the spine of the scapula. You have sustained a fracture to your scapula shoulder blade. Rehabilitation programs for nonoperative humeral fractures dr. Scapular fractures are uncommon, accounting for only 35% of shoulder girdle fractures and fewer than 1% of all fractures. Operative techniques in the management of scapular fractures. As the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Certain fracture patterns are seen in the scapula and are described by anatomic area for ease of discussion. Highenergy trauma is the most common cause, and scapular fractures are frequently associated with other acute injuries, including rib fracture 53%, lung injury 47%, head injury 39%, spinal fracture 29%, and clavicle fracture 25%. Traditionally, management of nonarticular scapular fractures has been conservative in nature. The scapula, or shoulder blade, is the bone located in the back. Fractures of the scapula university of pennsylvania orthopaedic. A significant subset of patients with scapula fractures also involves the glenoid neck bone joining the shoulder joint the scapular body.
Normally, the scapula is pretty well protected by a web of muscles and it is very rare that the scapula sustains a fracture. Scapular fractures non operative management 2 weeks sling, early motion orif glenohumeral instability 25% glenoid 5mm stepoff medialisation of glenoid open fracture scapula neck 40 degrees, 1cm coracoid 1cm displacement. The standard reference book in operative fracture care. Longitudinal fractures of the scapula should be considered when there is lateral instability of the shoulder after trauma. Mccartney wt, garvan cb 2008 muscle separation approach to scapular neck fractures in eight dogs. For over forty years, the principles regarding fracture management have been taught by ao, and these textbooks are a carefully edited version of the knowledge with contributing. Other scapula fractures could result pain and stiffness. Most scapular fractures occur secondary to vehicular trauma. Mbogwa s, lumb wv, smith kw, rubin r 1978 plating of scapular fractures.
Pdf ao principles of fracture management download full. The latter define the first days of hospitalization in polytraumatized patients. However, little agreement exists on indications for surgery, and there is no. Extraarticular fractures of the coracoid process, acromion process, neck, body, and spine account for the majority of scapular fractures. Rehabilitate r esuscitate advanced trauma life support. Each shoulder blade lies on the upper aspect of the back of the rib cage. Direct trauma is usually the cause of most scapula fractures. The main joint of the shoulder is the glenohumeral joint. Pain, tenderness, swelling, bruising, or a bump in the injured area. Once the fracture begins to heal it is important to keep the. A scapular fracture is a break in your shoulder blade scapula. Scapula fractures pediatric orthopaedic society of north.
However, most of the rib fracture patients did not have an effective medical treatment. Feb 03, 2020 a scapular fracture is a break in your shoulder blade scapula. The best prognosis for soundness is given for horses treated surgically. The shoulder blade scapula is located in the upper back, and sits on top of the ribs. Although patient outcomes can be largely affected by associated injuries, nonoperative management can yield quite satisfactory resuits in most cases of scapula fractures. May 30, 2017 the scapula has a substantial protective soft tissue envelope and considerable trauma is required to fracture it. Fractures of the scapula typically result from a highenergy bluntforce mechanism 37. Traditionally extraarticular fractures have been treated nonoperatively with mobilization of the affected limb as pain allows, with physiotherapy to maximize functional outcomes.
This joint comprises a ball the humeral head on a golfteeshaped joint the glenoid of the scapula. However, these highenergy injuries are being seen more often likely because of improved emergency response and trauma resuscitation. Any surgery poses some risk, such as nerve and blood vessel damage, bleeding, or infection. Dedicated scapular series ap, lateral, axillary will identify most fractures.
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 shoulder blade scapula is a triangularshaped bone that is protected by a complex system of surrounding muscles. The recommended radiographic views for a suspected scapula fracture are a true ap of the scapula, scapular y, and axillary lateral views. There is a groundswell of recognition that severe deformity from scapular malunion is. Treatment of the scapula fracture itself should be initiated during the phase of. With such clinical presentations, the treatment should include patient.
A direct approach through langers lines allows for easy exposure and direct visualization for an anatomic reduction of simple fractures through the shaft or base of the. Team explaining the ongoing management of your injury. Management historically, scapula fractures have been treated with closed means. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Thirty fractures 28% with an unstable shoulder girdle were classified as type c injuries. The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures. 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. The management of scapula fractures has evolved over recent years as new techniques and ap proaches have been promulgated. Management fracture management stages include 4 rs. Scapula fracture shoulder blade fracture johns hopkins. Non operative management 2 weeks sling, early motion orif glenohumeral instability 25% glenoid 5mm stepoff medialisation of glenoid open fracture scapula neck 40 degrees, 1cm coracoid 1cm displacement. General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs.
Jan 23, 20 there is a growing belief that nonoperative management of extraarticular scapula fractures is best reserved for those displaced less than 1520 mm and angulated less than 3045 secondary to uniformly good outcomes with nonoperative treatment 2, 20, 37, 3942. Shoulder injuries from trauma scapula nonunion hope tbi. Scapula fracture shoulder blade fracture physioadvisor. Shoulder trauma fractures and dislocations orthoinfo. Scapula fractures with injuries of the superior shoulder suspensory complex are often referred to as floating shoulders. Arthroscopic management stress exam to decide nonop slide 104 on. Treatment of type a injuries should be nonoperative. Whether or not a physical examination is conducted, the physician aims to get images of the chest and injured shoulder. If there are many fragments or it causes joint instability, surgery may be performed to nailplate the bones together, often followed by a period in a sling. Fractures of the scapula acta chirurgiae orthopaedicae et. Ruleout other injuries low threshold for additional ct imaging or obs. In addition to describing the management of these cases, we aimed to identify the patterns of scapula fracture related to specific injury mechanisms and to report any associated injuries that require attention. A displaced fracture can be adequately stabilized by internal fixation.
Scapular fracture aftercare instructions what you need. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Fractures of the scapula auer 2017 equine veterinary. N2 scapula fractures are rare injuries that typically occur in patients who have sustained a shoulder dislocation, as is the case with many fractures of the glenoid rim or highenergy trauma to the forequarter.
Scapula fractures in complex shoulder injuries and floating. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. Operative indications for these process fractures included a painful nonunion. Scapular fracture aftercare instructions what you need to. Fractures of the scapula occur very infrequently in small animal patients. Scapular fractures are often associated with other injuries. Rib fracture cases are one of the most common thoracic traumas, which accounts for about 23 of them. Scapula fracture this information will guide you through the next 6 weeks of your rehabilitation. The ideal methods for the management of rib fractures. Nabil ebraheim general scapula fractures 82012 7558 views. Shoulder fractures most often involve the clavicle collarbone, proximal humerus top of the upper arm bone, or the scapula shoulder blade.
Shoulder dislocations can involve any of the three different joints that make up the shoulder. Retain to maintain position while healing occurs by internal fixation, external fixation, or conservative methods 4. Scapular fractures are predominantly acquired during highyenergy trauma and. Several areas of the scapula may be involved simultaneously but fractures that involve the glenoid neck and scapular body are the most common. The emphasis of this article is on the management of these injuries. Therefore, they are frequently associated with severe injuries to the chest and skull. Most scapula fractures, however, are minimally displaced. Coimbra r, conroy c, tominaga gt, bansal v, schwartz a. The physician may recommend working with a physical therapist for rehabilitation.
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. Delayed operative management of fractures of the scapula. Most scapular fractures are managed effectively with closed treatment and medical management. Mar 23, 2020 scapular fractures include fractures of the body or spine of the scapula. More recently, indications for operative management have been described. Scapula fractures are uncommon injuries, representing 3% of all shoulder fractures. Fractures of the scapula, almost without exception, occur during highenergy trauma. Depending on the fracture pattern, three subgroups were defined. Shortterm immobilization in a sling and swathe bandage is provided for comfort. The most significant complications associated with scapular fractures are those that result from accompanying injuries to adjacent and distant. Scapular fracture classification animation everything you need to know dr. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. 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. Pain, swelling and bruising are the most common symptoms.
Treatment t scapula fracture injuries and associated injuries. Treatment depends on the amount of disruption there is to the bone. Historically, only unstable distal clavicle fractures were treated operatively. One of the earliest descriptions of treating scapula fractures was published in 1805 in desaults treatise on fractures. Scapula fractures in elite soccer and rugby players. The only type of scapula fracture expected to lead to posttraumatic intraarticular scapula fracture. 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 shoulder also has one articulation, which is the relationship between the scapula shoulder blade and the chest wall. 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. Displaced fractures of the scapula with a stable shoulder girdle were considered type b injuries and represented 18. Nov 26, 2017 more severe then scapula fracture which may delay diagnosis and treatment. 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. Dec 05, 2018 as the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Operative management of displaced glenoid fossa fractures and scapular neck fractures displaced 10mm lead in a better functional outcome.
However, recent wellconducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and nonunion, compared. Reduce if displaced may be by open reduction, closed manipulation, or traction 3. If the break is small or wellaligned, surgery may not be required. According to a statistical report, 300,000 patients in the us were diagnosed with rib fractures in 2004. Nonoperative treatments include the use of a sling or shoulder immobilizer, ice and pain medications. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. Shoulder trauma fractures and dislocations orthoinfo aaos. Hardegger et al reported that if significant displacement occurs.
Your collarbone, arm bones, lungs, or chest may also be affected. Dec 02, 2019 in the current study, we report our experience of the largest series of field sportsassociated scapula fractures to date. Direct force may cause fractures in all regions of the scapula, while indirect force via impaction of the humeral head into the glenoid fossa can cause both glenoid and scapular neck fractures. Multiple studies have documented poor functional outcomes following nonoperative management of displaced scapular fractures. Longterm functional outcomes of nonoperatively treated.