Scapular Fractures

Modern Study Review (AI-Generated)

High-Yield Summary

Scapular fractures are uncommon injuries typically resulting from high-energy trauma and are often associated with other thoracic or upper extremity injuries. Due to the scapula’s muscular envelope and mobility, many fractures are minimally displaced and managed non-operatively. However, intra-articular glenoid fractures or displaced fractures involving the scapular neck or body may require surgical intervention to restore shoulder function and prevent chronic pain or instability.

Key Diagnostic Findings

Anatomy

The scapula consists of the body, neck, glenoid fossa, acromion, spine, and coracoid process.
It serves as the attachment site for multiple muscles critical for shoulder motion and stability.

Clinical Presentation

Patients often present with shoulder pain, swelling, and limited range of motion after trauma.
Associated injuries (rib fractures, clavicle fractures, pneumothorax) are common and must be evaluated.
Physical exam may reveal localized tenderness over the scapula and crepitus with movement.

Imaging

Plain radiographs: AP, lateral scapular (Y-view), and axillary views are essential.
CT scan with 3D reconstruction is the gold standard for detailed assessment, especially for intra-articular glenoid fractures and complex patterns.

Classification Systems

Type	Description	Subtypes
Type I	Fractures of acromion, spine, or coracoid	A: Acromion B: Base of acromion or spine C: Coracoid
Type II	Neck fractures	A: Lateral to base of acromion/spine B: Extending to base of acromion or spine C: Transverse type
Type III	Glenoid fractures (intra-articular)	—
Type IV	Body fractures	—

Note: The Miller classification remains clinically relevant but is often supplemented by AO/OTA scapular fracture classifications and detailed glenoid fracture classifications (Ideberg, AO) in modern practice.

Current Gold Standard Treatment

Non-operative

Indicated for minimally displaced fractures, especially of the scapular body and processes.
Treatment includes immobilization in a sling, early passive range of motion progressing to active exercises.
Close monitoring for displacement or shoulder stiffness.

Operative

Indications:
Displaced intra-articular glenoid fractures (>5 mm step-off or >20% involvement).
Scapular neck fractures with >1 cm displacement or >40 degrees angulation.
Floating shoulder injuries (concomitant clavicle fracture with scapular neck fracture).
Symptomatic acromion or coracoid fractures causing impingement or instability.
Surgical approaches vary by fracture location; fixation aims to restore articular congruity and scapular alignment.

Modern Complications & Outcomes

Complications

Nonunion or malunion leading to chronic pain and dysfunction.
Post-traumatic shoulder stiffness or adhesive capsulitis.
Glenohumeral arthritis secondary to intra-articular involvement.
Neurovascular injury (rare but possible).
Hardware irritation or failure after surgery.

Outcomes

Most scapular body fractures treated non-operatively have excellent functional outcomes.
Surgical fixation of displaced fractures improves pain, range of motion, and reduces post-traumatic arthritis risk.
Early rehabilitation is critical to optimize shoulder function and minimize stiffness.

Classic Clinical Notes