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Brachial plexus injury
13%
238/1859
Ipsilateral clavicle fracture
8%
150/1859
Pelvic ring injury
3%
51/1859
Rib fracture
75%
1388/1859
Spine fracture
1%
24/1859
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Figure A demonstrates a scapula body fracture. Rib fractures are the most common orthopedic injury associated with these high-energy fractures, with a 52% incidence. Scapula fractures are associated with high-energy trauma and have a reported mortality rate of 2-5%. Approximately 50% of high-energy scapular fractures involve the body and spine. Most scapular fractures may be treated conservatively with sling immobilization followed by early motion with no expected functional deficits. Indications for operative management of scapular fractures include glenohumeral instability with >25% of glenoid involvement or >5mm of articular step-off, excessive medialization of the glenoid, displaced scapular neck or coracoid fractures, and open fractures. Baldwin et al. retrospectively reviewed 9,543 scapular fractures utilizing the US National Trauma Database. They reported that the most commonly associated fractures were rib fractures (52.9%), followed by fractures of the spine (29.2%), clavicle (25.2%), and pelvis (15.3%). They concluded that lung and head injuries occurred in 47.1% and 39.1% of the cases, respectively. Brown et al. retrospectively reviewed the association between scapular fractures (SF) and blunt thoracic aortic injury (BTAI). They found that in 35,541 blunt trauma admissions, SF and BTAI occurred in 1.1% and 0.6% of patients, respectively. They noted that most of the patients with SF had associated injuries (99%), but only four patients with SF had BTAI. The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. They concluded that SF is uncommon after blunt trauma, but patients with SF almost always have significant associated injuries and indicates a high amount of energy. Figure A demonstrates a high-energy scapular body fracture which may benefit from surgical intervention Incorrect Answers: Answers 1-3,5: Fractures of the spine (29.2%), clavicle (25.2%), and pelvis (15.3%) are all associated with high-energy scapula fractures, but occur less commonly than rib fractures (52%)
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