eMedicine Specialties > Orthopedic Surgery > Shoulder

Scapula Fracture: Workup

Author: Thomas P Goss, MD, Chief of Shoulder Surgery, Professor, Department of Orthopedic Surgery, University of Massachusetts Memorial Health Care
Coauthor(s): Robert V Cantu, MD, Staff Physician, Department of Orthopedics, University of Massachusetts Medical Center
Contributor Information and Disclosures

Updated: Dec 19, 2008

Workup

Laboratory Studies

  • Laboratory evaluation for patients with a scapula fracture that results from a high-energy mechanism generally is the same as that of a trauma patient. The following studies are warranted:
    • Complete blood count (CBC)
    • Electrolytes
    • BUN/creatinine
    • Urinalysis
    • Prothrombin time/partial thromboplastin time (PT/aPTT)
    • Type and cross-match

Imaging Studies

  • Plain radiographs
    • Obtain radiographs for the shoulder trauma series, including anteroposterior (AP), lateral, and axillary views of the shoulder/scapula.
    • If an injury to the scapuloclavicular linkage is suspected, obtain a stress AP projection with weights.
    • Occasionally, oblique views may be helpful.
  • CT scan
    • Most displaced scapula fractures should be evaluated with CT scanning, especially if operative intervention is planned.
    • CT scan helps visualize the complex osseous anatomy of the scapula.
    • Reconstruction views also help define the anatomy (3-dimensional CT scan in the most complex injuries).
  • Arteriography: In patients with a pulseless upper extremity, emergently perform arteriography to define the vascular injury.

Other Tests

  • Electromyogram
    • Electromyogram (EMG) testing can be performed 3 weeks after injury in patients with a scapula fracture and brachial plexus injury.
    • EMG testing is useful to assess the extent of the injury and potential for recovery, if any.
  • Cervical myelogram - can be performed at 6 weeks in patients with a neurologic deficit due to a scapular injury.

Histologic Findings

Histologic evaluation generally is not part of the workup in cases of scapula fractures.

Staging

  • Classification of fractures involving the glenoid cavity includes types I-VI.
    • Type IA - Anterior rim fracture
    • Type IB - Posterior rim fracture
    • Type II - Fracture line through the glenoid fossa exiting at the lateral border of the scapula
    • Type III - Fracture line through the glenoid fossa exiting at the superior border of the scapula
    • Type IV - Fracture line through the glenoid fossa exiting at the medial border of the scapula
    • Type VA - Combination of types II and IV
    • Type VB - Combination of types III and IV
    • Type VC - Combination of types II, III, and IV
    • Type VI - Comminuted fracture (see Image below and  Image 1 in Multimedia)



(Click Image to enlarge.) Classification of gleno...

(Click Image to enlarge.) Classification of glenoid cavity fractures: IA - Anterior rim fracture; IB - Posterior rim fracture; II - Fracture line through the glenoid fossa exiting at the lateral border of the scapula; III - Fracture line through the glenoid fossa exiting at the superior border of the scapula; IV - Fracture line through the glenoid fossa exiting at the medial border of the scapula; VA - Combination of types II and IV; VB - Combination of types III and IV; VC - Combination of types II, III, and IV; VI - Comminuted fracture

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(Click Image to enlarge.) Classification of gleno...

(Click Image to enlarge.) Classification of glenoid cavity fractures: IA - Anterior rim fracture; IB - Posterior rim fracture; II - Fracture line through the glenoid fossa exiting at the lateral border of the scapula; III - Fracture line through the glenoid fossa exiting at the superior border of the scapula; IV - Fracture line through the glenoid fossa exiting at the medial border of the scapula; VA - Combination of types II and IV; VB - Combination of types III and IV; VC - Combination of types II, III, and IV; VI - Comminuted fracture

  • Classification of fractures of the glenoid neck includes types I and II.
    • Type I - Includes all nondisplaced or minimally displaced fractures
    • Type II - Includes all significantly displaced fractures (translational displacement equal to or greater than 1 cm or angulatory displacement equal to or greater than 40°)

More on Scapula Fracture

Overview: Scapula Fracture
Workup: Scapula Fracture
Treatment: Scapula Fracture
Follow-up: Scapula Fracture
Multimedia: Scapula Fracture
References
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References

  1. Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Joint Surg [Br]. Nov 1984;66(5):725-31. [Medline].

  2. Tadros AM, Lunsjo K, Czechowski J, Abu-Zidan FM. Multiple-region scapular fractures had more severe chest injury than single-region fractures: a prospective study of 107 blunt trauma patients. J Trauma. Oct 2007;63(4):889-93. [Medline].

  3. Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: a marker for concomitant injury? A retrospective review of data in the national trauma database. J Trauma. Aug 2008;65(2):430-5. [Medline].

  4. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop. Aug 1991;(269):174-80. [Medline].

  5. Goss TP. Scapular Fractures and Dislocations: Diagnosis and Treatment. J Am Acad Orthop Surg. Jan 1995;3(1):22-33. [Medline].

  6. Ideberg R. Unusual glenoid fractures: a report on 92 cases. 1987;58:191-2.

  7. Goss TP. Fractures of the glenoid cavity. J Bone Joint Surg [Am]. Feb 1992;74(2):299-305. [Medline].

  8. DePalma AF. Surgery of the Shoulder. 3rd ed. 1983.

  9. Soslowsky LJ, Flatow EL, Bigliani LU, Mow VC. Articular geometry of the glenohumeral joint. Clin Orthop Relat Res. Dec 1992;181-90. [Medline].

  10. Kavanagh BF, Bradway JK, Cofield RH. Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa. J Bone Joint Surg Am. Apr 1993;75(4):479-84. [Medline].

  11. Nordqvist A, Petersson C. Fracture of the body, neck, or spine of the scapula. A long-term follow- up study. Clin Orthop. Oct 1992;(283):139-44. [Medline].

  12. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 1993;7(2):99-106. [Medline].

  13. Herscovici D Jr, Fiennes AG, Allgower M. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Joint Surg [Br]. May 1992;74(3):362-4. [Medline].

  14. Burke CS, Roberts CS, Nyland JA, Radmacher PG, Acland RD, Voor MJ. Scapular thickness--implications for fracture fixation. J Shoulder Elbow Surg. Sep-Oct 2006;15(5):645-8. [Medline].

  15. Lantry JM, Roberts CS, Giannoudis PV. Operative treatment of scapular fractures: a systematic review. Injury. Mar 2008;39(3):271-83. [Medline].

  16. Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma. Mar 2006;20(3):230-3. [Medline].

  17. Butters KP. The scapula. In: The Shoulder. Vol 1. 1990:335-66.

  18. Goss TP. Fractures of the glenoid neck. J Shoulder Elbow Surg. 1994;3:42-52.

  19. Goss TP. Glenoid fractures: Open reduction internal fixation. In: Master Techniques in Orthopaedic Surgery. 1998:3-17.

  20. Goss TP. The scapula: coracoid, acromial, and avulsion fractures. Am J Orthop. Feb 1996;25(2):106-15. [Medline].

  21. Miller ME, Ada JR. Fractures of the scapula, clavicle, and glenoid. In: Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Vol 2. 1992:1291-1310.

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Further Reading

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Keywords

scapula fracture, glenoid fracture, acromion fracture, coracoid fracture, scapulothoracic dissociation, double disruption of the superior shoulder suspensory complex

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Contributor Information and Disclosures

Author

Thomas P Goss, MD, Chief of Shoulder Surgery, Professor, Department of Orthopedic Surgery, University of Massachusetts Memorial Health Care
Thomas P Goss, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Massachusetts Medical Society, and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert V Cantu, MD, Staff Physician, Department of Orthopedics, University of Massachusetts Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Lynn A Crosby, MD, FACS, Chief of Shoulder Division, Professor, Department of Orthopedic Surgery, Wright State University School of Medicine
Lynn A Crosby, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Fracture Association, American Medical Association, American Medical Tennis Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Arthroscopy Association of North America, Mid-America Orthopaedic Association, and Orthopaedic Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Pekka A Mooar, MD, Professor, Department of Orthopedic Surgery, Temple University School of Medicine
Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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