Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Scapular Fracture

  • Author: Joseph C Schmidt, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Oct 21, 2015
 

Background

The primary function of the scapula is to attach the upper extremity to the thorax and provide a stabilized platform for upper extremity movement. The scapula is attached to the clavicle by the acromioclavicular and coracoclavicular ligaments and articulates with the humerus. The scapula is protected by its surrounding musculature (supraspinatus, infraspinatus, subscapularis) and its ability to move along the wall of the thorax; the body and spine of the scapula are most protected. Fractures to scapular structures typically require significant force. These factors explain the infrequent occurrence of scapular fractures.

Scapular fractures can be divided by location[1] :

  • Body (spine) fractures
  • Acromion fractures
  • Neck fractures
  • Glenoid fractures

Scapula fractures have been found to be associated with the following[1] :

  • Pneumothorax
  • Pulmonary contusions
  • Clavicle fractures
  • Rib fractures

Fractures of the acromion are generally caused by a significant blunt force to the shoulder that is directed anteriorly. Fractures of the glenoid neck often occur as the result of falling on an outstretched arm, as well as blunt force, and may be associated with humerus fractures or shoulder dislocation.[1]

Glenoid fractures may occur from a direct lateral blow to the shoulder or a force transmitted from the humerus, such as falling on the elbow. Glenoid fossa fractures constitute about 50% of scapular fractures, and glenoid rim fractures about 7% of all scapular fractures.[1]

Up to 90% of scapular fractures are nondisplaced. Most scapular fractures will heal within 6 weeks, but it may take months before full functional recovery is achieved.[1]

Next

Pathophysiology

The primary anatomic features of the scapula provide insight into the mechanisms of injury and offer a convenient classification system. Injuries to the body or the spine of the scapula typically result from a direct blow with significant force, as depicted in the image below, such as from a motor vehicle accident or a fall.

Scapular anatomy. Muscle origin and insertion. Scapular anatomy. Muscle origin and insertion.

Scapular fractures are caused by different mechanisms. Acromion injuries usually result from a direct downward force to the shoulder. Scapular neck fractures most frequently result from an anterior or posterior force applied to the shoulder. Glenoid rim fractures most often result from force transmitted along the humerus after a fall onto a flexed elbow. Stellate glenoid fractures usually follow a direct blow to the lateral shoulder. Finally, coracoid process fractures may result from either a direct blow to the superior aspect of the shoulder or a forceful muscular contraction that causes an avulsion fracture. Classification of these fractures is depicted below.

Classification of glenoid cavity fractures: IA - A 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

The AO Foundation and Orthopaedic Trauma Association also developed a comprehensive system for in-depth classification of scapular fractures for clinical research and surgical decision making.[2, 3]

Previous
Next

Epidemiology

Scapular fractures occur infrequently and account for approximately 1% of all fractures and 3% to 5% of shoulder girdle injuries.[4, 5]

Morbidity and mortality result primarily from associated injuries. Traditional wisdom holds that scapular fractures serve as markers of increased morbidity and mortality in patients with blunt trauma. One retrospective study comparing patients with scapular fractures due to blunt trauma with control subjects matched for age, sex, and mechanism of injury demonstrated an increase in associated thoracic injuries yet revealed no difference in mortality or neurovascular injury.[6] Another study confirmed an association between scapular fractures and concomitant injuries but noted that most of the association could be explained by differences in injury severity scores.[7]

A large force is usually required to fracture the scapula, particularly the body or the spine; however, suspect scapular fractures and thoroughly search for associated injuries.

Scapular fractures are more common among men than among women because of their increased incidence of significant blunt trauma. Scapular fractures predominate in persons aged 25-40 years because of the increased occurrence of significant blunt trauma in this population.

Previous
 
 
Contributor Information and Disclosures
Author

Joseph C Schmidt, MD Associate Professor, Vice Chair and Chief, Department of Emergency Medicine, Baystate Medical Center

Joseph C Schmidt, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Michelle Ervin, MD Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Bonz J, Tinloy B. Emergency department evaluation and treatment of the shoulder and humerus. Emerg Med Clin North Am. 2015 May. 33 (2):297-310. [Medline].

  2. Audige L, Kellam JF, Lambert S, Madsen JE, Babst R, Andermahr J, et al. The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement. J Shoulder Elbow Surg. 2013 Sep 27. [Medline].

  3. Audige L, Kellam JF, Lambert S, Madsen JE, Babst R, Andermahr J, et al. The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement. J Shoulder Elbow Surg. 2014 Feb. 23 (2):189-96. [Medline].

  4. 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. 2006 Mar. 20(3):230-3. [Medline].

  5. Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med. 2013 Mar. 6 (1):79-87. [Medline].

  6. Stephens NG, Morgan AS, Corvo P, Bernstein BA. Significance of scapular fracture in the blunt-trauma patient. Ann Emerg Med. 1995 Oct. 26(4):439-42. [Medline].

  7. 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. 2008 Aug. 65(2):430-5. [Medline].

  8. McAdams TR, Blevins FT, Martin TP, DeCoster TA. The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma. 2002 Jan. 16(1):7-11. [Medline].

  9. Bartonicek J, Tucek M, Fric V. [Radiographic evaluation of scapula fractures]. Rozhl Chir. 2009 Feb. 88(2):84-8. [Medline].

  10. Bartonicek J, Tucek M, Fric V, Obruba P. Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop. 2014 Oct. 38 (10):2163-73. [Medline].

  11. Dienstknecht T, Horst K, Pishnamaz M, Sellei RM, Kobbe P, Berner A. A meta-analysis of operative versus nonoperative treatment in 463 scapular neck fractures. Scand J Surg. 2013 Jun 1. 102(2):69-76. [Medline].

  12. Hart RG, Rittenberry TJ, Uehara DT. Handbook of Orthopaedic Emergencies. Lippincott-Raven; 1999. 149-55.

  13. Ohman R, Ridell M. Selective enzyme staining procedures for characterization of mycobacterial immunoprecipitates. Int Arch Allergy Appl Immunol. 1986. 79(2):145-8. [Medline].

  14. Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. Mosby Year Book; 2002. 584-586.

  15. Simon R, Koenigcknecht S. Emergency Orthopedics: The Extremities. Appleton and Lange; 1995. 207-15.

  16. Tintinelli J, Ruiz E, Krome R. Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill; 2000. 1784-1787.

  17. Veysi VT, Mittal R, Agarwal S, Dosani A, Giannoudis PV. Multiple trauma and scapula fractures: so what?. J Trauma. 2003 Dec. 55(6):1145-7. [Medline].

 
Previous
Next
 
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).
Scapular anatomy. Muscle origin and insertion.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.