Scapula Fracture Clinical Presentation

Updated: Jun 15, 2018
  • Author: Thomas P Goss, MD; Chief Editor: S Ashfaq Hasan, MD  more...
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Presentation

History and Physical Examination

Most patients with scapula fractures present after high-energy trauma. Associated injuries are common and may delay the diagnosis. Associated injury patterns commonly involve the ipsilateral upper extremity and thorax. Frequencies of associated injuries are as follows:

Typically, physical examination reveals swelling, tenderness, crepitus, and ecchymosis over the scapular region. Perform a careful neurovascular examination to rule out arterial injury or brachial plexopathy.

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Complications

The most significant complications associated with scapular fractures are those that result from accompanying injuries to adjacent and distant osseous and soft-tissue structures. On average, there are 3.9 additional injuries, with the ipsilateral shoulder girdle, upper extremity, lung, and chest wall being affected most commonly. Pulmonary injuries, such as hemopneumothorax or pulmonary contusion, occur in 15-55% of cases. Cerebral contusions occur in 10-40% of cases, with central neurologic deficits in 5% of cases. Splenectomy is required in 8% of patients, and the mortality is 2%.

Complications related to the scapular fractures themselves are relatively uncommon. Nonunion is rare. Malunion can occur in a variety of forms, depending on the particular fracture type. Malunion of a scapular body fracture generally is well tolerated, though painful scapulothoracic crepitus has been described. Fractures of the glenoid cavity can result in symptomatic glenohumeral degenerative joint disease and instability. Angulated fractures of the glenoid neck can result in shoulder instability. Fractures of the glenoid neck with translational displacement can lead to altered mechanics of the surrounding soft tissues, giving rise to glenohumeral pain and dysfunction.

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