Scapular fracture
Background
Scapula anatomy.
Scapula anatomy.
- Occurs via direct trauma to shoulder area or FOOSH
- Fractures of body and glenoid are most common
- >75% are associated with other injuries (ribs, lung, shoulder girdle)
- Association with thoracic aortic injury classically taught, but actually <1% association in clinical practice
Clinical Features
- Localized tenderness over scapula with ipsilateral arm held in adduction
- Any arm movement will worsen pain
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Cardiac injury
- Blunt cardiac injury
- Penetrating cardiac injury
- Cardiac tamponade
- Traumatic aortic transection
- Cardiac injury
- Musculoskeletal
- Other
Evaluation
X-ray showing a fracture of the scapula and clavicle.
A right sided scapula fracture with rib fractures underneath seen on a 3D reconstruction of a CT scan.
- Dedicated scapular series (AP, lateral, axillary) will identify most fractures
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Rule-out other injuries
- Low threshold for additional CT imaging or obs
- Sling, ice
Disposition
- Typically discussed with orthopedic specialist with in ED
- If no other injuries of significance, may be discharged home
Sub-Specialty Care
Indications for surgery:
- Glenohumeral instability
- Displaced scapular neck fracture
- Open fracture
- Loss of rotator cuff function
- Displaced coracoid fracture
See Also
- Fractures (Main)
References
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