Scapula Fracture Workup

  • Author: Thomas P Goss, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Nov 10, 2011
 

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
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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).[16]
  • Arteriography: In patients with a pulseless upper extremity, emergently perform arteriography to define the vascular injury.
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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.
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Histologic Findings

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

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Staging

  • Classification of fractures involving the glenoid cavity includes types I-VI. (Click Image to enlarge.) Classification of glenoi(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
    • 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
  • 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°)
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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  Division Leader, Orthopedic Trauma, Department of Orthopedics and Sports Medicine, Darthmouth-Hitchcock Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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

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.

References

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(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 glenoid neck fractures. Type I includes all minimally displaced fractures. Type II includes all significantly displaced fractures (translational displacement greater than or equal to 1 cm; angulatory displacement greater than or equal to 40°)
Superior shoulder suspensory complex. (A) anteroposterior view of the bony/soft tissue ring and the superior and inferior bony struts; and (B) lateral view of the bony/soft tissue ring.
Fixation of acromion fractures. (A) tension band construct; and (B) plate-screw fixation (most appropriate for proximal fractures).
(Click Image to enlarge.) Scapular anatomy. Muscle origin and insertion.
Illustrations depicting fixation techniques available for stabilization of fractures of the glenoid cavity. (1) interfragmentary compression screw; (2) Kirschner wires; (3) construct using Kirschner wires and cerclage wires or Kirschner wires and cerclage sutures; (4) cerclage wire or suture; (5) staple; and (6) 3.5-mm malleable reconstruction plate.
Fixation of glenoid neck fractures. (A) stabilization with a 3.5-mm malleable reconstruction plate (note the Kirschner wire running from the acromial process to the glenoid process that can be used for either temporary or permanent fixation); (B) stabilization with 3.5-mm cannulated interfragmentary screws; and (C) stabilization with Kirschner wires (in this case, Kirschner wires passed from the acromion and clavicle into the glenoid process).
Illustrations showing techniques for managing coracoid fractures. (A) interfragmentary screw fixation (if the fragment is sufficiently large and noncomminuted), and (B) excision of the distal fragment (if small and/or comminuted) and suture fixation of the conjoined tendon to the remaining coracoid process.
 
 
 
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