Fracture of scapula

Scapula fracture

A scapula fracture is an uncommon injury. The scapula, or shoulder blade, is a wide, flat bone that sits behind the rib cage. The scapula connects to the clavicle (collar bone) in the front of the body, and to the humerus (arm bone) at the side. Part of the scapula is lined with cartilage (the glenoid) and forms the socket of the ball-and-socket shoulder joint.

Types of scapula fractures

  • Scapular Body Fractures : Scapular body fractures are the most common type of scapula fracture. These injuries seldom require any specific treatment more than a simple arm sling. The important fact is that scapular body fractures are commonly (80-90%) associated with other injuries such as lung and chest injuries.
  • Scapular Neck Fractures : Scapular neck fractures occur just adjacent to the glenoid–part of the shoulder joint. Again, most of these fractures can be treated without surgery unless there is significant angulation of the broken bones. In these cases, the shoulder joint can be affected if surgery is not done to realign the bones.
  • Glenoid Fractures : Glenoid fractures involve the cartilage surfaces of the shoulder joint. These fractures require surgery when the should joint becomes unstable or if the fragments are far out of alignment. Patients with glenoid fractures are at risk of developing shoulder arthritis

Symptoms

Symptoms include:

  • Extreme pain when you move the arm.
  • Swelling around the back of the shoulder.
  • Skin abrasions.

Without treatment, a fractured scapula can result in chronic shoulder pain and disability.

Diagnosis

To determine appropriate treatment, your doctor will probably need to take X-rays (radiographs) of your shoulder and chest to describe and classify the location(s) of fracture to the scapula. In some instances, your doctor may also need to use other diagnostic imaging tools such as computed tomography (CT).

One or more parts of the scapula may be fractured:

  • Scapular body (50% to 60% of patients)
  • Scapular neck (25% of patients)
  • Glenoid
  • Acromion
  • Coracoid

Treatment

Nonsurgical treatment with a simple sling works for most fractures of the scapula. The immobilization device holds your shoulder in place while the bone heals. Your doctor may want you to start early range-of-motion exercises within the first week after the injury. Other fractures may need 2 to 4 weeks of immobilization.

Your shoulder may feel stiff when the doctor removes the sling. Begin limited active use of your shoulder immediately. Passive stretching exercises should be continued until complete shoulder motion returns. This may take 6 months to 1 year.

If you have an isolated scapular body fracture, your doctor may want you to stay in the hospital. Certain types of scapular fractures may need further evaluation:

  • Fractures of the glenoid articular surface in which bone has moved out of place (displaced) significantly.
  • Fractures of the neck of the scapula with severe angular deformity.
  • Fractures of the acromion process with impingement syndrome.

In these instances, you may need surgery in which the doctor uses plates and screws to hold the bone together.