Scapular Fracture Treatment & Management
- Author: Joseph C Schmidt, MD; Chief Editor: Rick Kulkarni, MD more...
Prehospital Care
- Prehospital care involves transport, with immobilization of the affected extremity.
- Because of the significant forces involved in producing a scapular fracture, consider life-threatening associated injuries.
Emergency Department Care
The following discussion of the ED treatment of scapular fractures assumes that a prudent search for associated injuries revealed negative findings.
Body or spine fracture
Use of ice, analgesics, and sling and swath immobilization suffice for most fractures to the body or spine of the scapula.
Early range-of-motion exercises are recommended.
Acromion fracture
Nondisplaced fractures of the acromion usually can be treated with sling immobilization, ice, and analgesics.
Displaced fractures and those associated with rotator cuff injuries often require surgical intervention, strategies depicted below.
Fixation of acromion fractures. (A) tension band construct; and (B) plate-screw fixation (most appropriate for proximal fractures). Neck fracture
Manage nondisplaced scapular neck fractures with a sling, ice, analgesics, and early range-of-motion exercises.
Displaced neck fractures, as in the image below, require urgent orthopedic consultation for traction or surgical reduction.
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°) Glenoid fracture
Small and minimally displaced glenoid rim fractures usually respond to conservative therapy with a sling, ice, and analgesics, followed by early range-of-motion exercises.
Large or significantly displaced fractures, as well as those associated with triceps impairment, often require surgical treatment.
All stellate glenoid fractures require early orthopedic consultation.
Coracoid fracture
Coracoid fractures respond well to conservative therapy with sling immobilization, ice, analgesics, and early mobilization.
Consultations
Follow-up care with an orthopedic surgeon is advised in all cases because of the possibility of long-term complications such as bursitis and posttraumatic arthritis.
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].
Stephens NG, Morgan AS, Corvo P, Bernstein BA. Significance of scapular fracture in the blunt-trauma patient. Ann Emerg Med. Oct 1995;26(4):439-42. [Medline].
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].
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. Jan 2002;16(1):7-11. [Medline].
Bartonicek J, Tucek M, Fric V. [Radiographic evaluation of scapula fractures]. Rozhl Chir. Feb 2009;88(2):84-8. [Medline].
Hart RG, Rittenberry TJ, Uehara DT. Handbook of Orthopaedic Emergencies. Lippincott-Raven; 1999:149-55.
Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. Mosby Year Book; 2002:584-586.
Simon R, Koenigcknecht S. Emergency Orthopedics: The Extremities. Appleton and Lange; 1995:207-15.
Tintinelli J, Ruiz E, Krome R. Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill; 2000:1784-1787.
Veysi VT, Mittal R, Agarwal S, Dosani A, Giannoudis PV. Multiple trauma and scapula fractures: so what?. J Trauma. Dec 2003;55(6):1145-7. [Medline].
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