Scapular Fracture Treatment & Management

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

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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