Scapula Fracture Workup

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

Laboratory Studies

Laboratory evaluation for patients with a scapula fracture that results from a high-energy mechanism generally is the same as that of a trauma patient. The following studies are warranted:

  • Complete blood count (CBC)
  • Electrolytes
  • Blood urea nitrogen (BUN)/creatinine
  • Urinalysis
  • Prothrombin time (PT)/activated partial thromboplastin time (aPTT)
  • Type and cross-match
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Imaging Studies

Radiography

Obtain plain radiographs for the shoulder trauma series, including anteroposterior (AP), lateral, and axillary views of the shoulder/scapula. If an injury to the scapuloclavicular linkage is suspected, obtain a stress AP projection with weights. Occasionally, oblique views may be helpful.

In patients with a pulseless upper extremity, perform emergency arteriography to define the vascular injury.

Computed tomography

Most displaced scapula fractures should be evaluated by means of computed tomography (CT), especially if operative intervention is planned. CT helps visualize the complex osseous anatomy of the scapula. Reconstruction views also help define the anatomy (three-dimensional [3D] CT is useful for the most complex injuries). [14]  Dugarte et al found 3D fracture mapping strategies to be superior to two-dimensional (2D) strategies for 3D CT reconstructions of scapula neck and body fractures. [15]

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Other Tests

Electromyography (EMG) can be performed 3 weeks after injury in patients with a scapula fracture and brachial plexus injury. EMG is useful for assessing the extent of the injury and potential for recovery, if any.

Cervical myelography can be performed at 6 weeks in patients with a neurologic deficit due to a scapular injury.

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Classification

Fractures involving the glenoid cavity may be classified into the following types (see the image below):

  • Type IA - Anterior rim fracture
  • Type IB - Posterior rim fracture
  • Type II - Fracture line through the glenoid fossa exiting at the lateral border of the scapula
  • Type III - Fracture line through the glenoid fossa exiting at the superior border of the scapula
  • Type IV - Fracture line through the glenoid fossa exiting at the medial border of the scapula
  • Type VA - Combination of types II and IV
  • Type VB - Combination of types III and IV
  • Type VC - Combination of types II, III, and IV
  • Type VI - Comminuted fracture
(Click Image to enlarge.) Classification of glenoi (Click Image to enlarge.) 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

Fractures of the glenoid neck may be classified into the following two types:

  • Type I - Includes all nondisplaced or minimally displaced fractures
  • Type II - Includes all significantly displaced fractures (translational displacement equal to or greater than 1 cm or angulatory displacement equal to or greater than 40°)

Bartonicek et al described a clinically oriented classification of scapular body fractures based on involvement of the pillars of the scapular body as seen on 3D CT, as follows [16] :

  • Fracture of spinal pillar
  • Fracture of lateral pillar (two-part, three-part, comminuted)
  • Fracture of both pillars (medial, central)
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