Scapula fractures

Scapula fractures are rare injuries that typically occur in patients who have sustained a shoulder dislocation, as is the case with many fractures of the glenoid rim or high-energy trauma to the forequarter. An elevated suspicion for other abnormality, especially life-threatening injuries to the cranium, cervical spine, and thorax, should underlie the diagnostic workup. A physical examination should uncover common injuries to the brachial plexus, axillary artery, as well as ipsilateral musculoskeleton. A review of the AP and axial view of the shoulder and a scapula-Y radiograph should then guide the need for a CT scan. A displaced intra-articular glenoid fracture is the least disputed surgical indication. Double disruptions of the superior shoulder suspensory complex, significant angulatory and translatory displacement of the scapula neck, marked medialization of the glenoid, and displaced scapula process fractures are relative operative indications that must be placed in the context of a patient's lifestyle, work demands, and extremity dominance. Although patient outcomes can be largely affected by associated injuries, nonoperative management can yield quite satisfactory resuits in most cases of scapula fractures. Most scapula fractures, however, are minimally displaced. For scapula fractures that are intra-articular, markedly displaced, or associated with other injuries to the shoulder suspensory complex, excellent outcomes also can be realized with operative intervention, assuming a well-executed operation and plan of rehabilitation.