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Scapular Fracture Treatment & Management

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

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.

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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 c 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.

Fractures of the scapular neck can be divided into stable fractures, fractures with rotational instability, and fully unstable fractures. Accurate diagnosis can be helped by 3D CT reconstructions. Undisplaced or minimally displaced fractures may be treated nonoperatively.[10]  Displaced neck fractures, as in the image below, require urgent orthopedic consultation for traction or surgical reduction.[11]

Classification of glenoid neck fractures. Type I i 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.

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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.

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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
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  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].

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  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].

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  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].

 
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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.
 
 
 
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