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Review Question - QID 345

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QID 345 (Type "345" in App Search)
A 35-year-old male is involved in a motor vehicle accident and suffers the fracture shown in Figure A. This is an isolated shoulder injury, and he has no neurologic deficits on physical exam. CT scan of the scapula shows the glenoid to be translated medially 3mm, and anglulated 20 degrees from its anatomic axis. What is the most appropriate initial treatment for this injury?
  • A

Immobilization in sling x 2 weeks then PT

53%

1028/1953

Immobilization in sling x 8 weeks then PT

7%

133/1953

ORIF via a deltopectoral approach

7%

137/1953

ORIF via a posterior approach

32%

634/1953

ORIF via a lateral approach

1%

10/1953

  • A

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The radiographs are consistent with a extra-articular glenoid neck fracture, which by definition is not significantly displaced. These fractures are best treated with a sling (2 weeks) and early mobilization. Significantly displaced fractures, have translational displacement greater than or equal to 1 cm or angulatory displacement greater than or equal to 40°. These typically need ORIF.

A schematic of the fracture types is shown in Illustration A.

McGahan et al review the epidemiology of scapula fractures and advocate conservative treatment with early mobilization.

Van Noort et al reviewed 13 scapular neck fractures and found that non-operative treatment in the absence of ipsilateral shoulder injury and associated neurological impairment lead to good functional outcomes, with or without significant translational displacement of the fracture.

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