Scapular Fracture Treatment & Management
- Author: Joseph C Schmidt, MD; Chief Editor: Trevor John Mills, MD, MPH more...
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.
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.
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. Displaced neck fractures, as in the image below, require urgent orthopedic consultation for traction or surgical reduction.
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 fractures respond well to conservative therapy with sling immobilization, ice, analgesics, and early mobilization.
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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