summary Scapula Fractures are uncommon fractures to the shoulder girdle caused by high energy trauma and associated with pulmonary injury, head injury, and increased injury severity scores. Diagnosis can be made with plain radiographs and CT studies are helpful for fracture characterization and surgical planning. Treatment is usually nonoperative with a sling. Surgical management is indicated for intra-articular fractures, displaced scapular body/neck fractures, open fractures, and those associated with glenohumeral instability. Epidemiology Incidence rare login to view 2 more bullets Demographics age login to view 1 more bullet males > females Location scapular body/spine = 45-50% glenoid = 35% login to view 3 more bullets acromion = 8% coracoid = 7% Etiology Pathophysiology mechanism of injury login to view 9 more bullets Associated injuries (in 80-95%) medical login to view 4 more bullets orthopaedic login to view 12 more bullets Anatomy Osteology scapular body login to view 30 more bullets Arthrology glenohumeral joint login to view 2 more bullets scapulothoracic joint login to view 2 more bullets acromioclavicular (AC) joint login to view 3 more bullets superior shoulder suspensory complex login to view 7 more bullets Blood supply contributions from anterior and posterior circumflex, scapular circumflex and suprascapular arteries watershed area present in anterosuperior glenoid Nervous system scapula is intimately associated with brachial plexus axillary nerve is at risk inferior to the glenoid as it runs from anterior to posterior compression of suprascapular nerve at scapular notch leads to supraspinatus/infraspinatus weakness, with compression at the spinoglenoid notch leading only to infraspinatus weakness Biomechanics scapula contributes to glenohumeral rotation and abduction login to view 1 more bullet Classification Classification is based on the location of the fracture and includes scapular body fractures login to view 1 more bullet scapular neck fractures login to view 2 more bullets glenoid fractures login to view 4 more bullets acromial fractures login to view 1 more bullet coracoid fractures login to view 2 more bullets scapulothoracic dissociation Ogawa Coracoid Fracture Classification Type I Fracture occurs proximal to the coracoclavicular ligament Type II Fracture occurs towards the tip of the coracoid Kuhn Acromial Fracture Classification Type I Nondisplaced or minimally displaced Type II Displaced but does not compromise the subacromial space Type III Displaced and compromises the subacromial space Ideberg Classification of Glenoid Fracture Type Ia Anterior rim fracture Type Ib Posterior rim fracture Type II Fracture line through glenoid fossa exiting scapula inferiorly Type III Fracture line through glenoid fossa exiting scapula superiorly Type IV Fracture line through glenoid fossa exiting scapula medially through body Type Va Combination of types II and IV Type Vb Combination of types III and IV Type Vc Combination of types II, III, and IV Type VI Severe comminution AO Classification for Glenoid Fractures Fracture type Subtype Qualification 14F0: Extra-articular Glenoid neck 14F1: Simple, intra-articular 1.1: anterior glenoid rim 1.2: posterior glenoid rim 1.3: transverse/short oblique f: infraequitorial, single quadrant r: supraequatorial, 2 quadrants t: infraequitorial, 2 quadrants i: infraequitorial e: equitorial p: supraequitorial 14F2: Multifragmentary 2.1: >= 3 articular fragments 2.2: central fracture-dislocation 14B: Extension into body 1: exits body at <=2 points 2: exits body at >=3 points presentation History traumatic direct blow to shoulder or fall on outstretched arm scapula fracture may be missed or diagnosed late in presence of other distracting, traumatic injuries Symptoms diffuse, severe shoulder pain systemic symptoms login to view 2 more bullets Physical exam inspection login to view 9 more bullets motion login to view 3 more bullets neurovascular login to view 6 more bullets Imaging Radiographs recommended views login to view 5 more bullets measurements login to view 7 more bullets CT indications login to view 3 more bullets views login to view 3 more bullets MRI indications login to view 1 more bullet differential Os Acromiale unfused secondary ossification centers (meso- and meta-acromion) login to view 1 more bullet Treatment Nonoperative sling for 2-3 weeks, followed by early motion login to view 38 more bullets Operative open reduction internal fixation login to view 48 more bullets Techniques Nonoperative (immobilization) noninvasive but can lead to stiffness technique login to view 1 more bullet Open Reduction Internal Fixation (ORIF) scapular body/neck fractures login to view 18 more bullets intra-articular glenoid fractures login to view 25 more bullets acromion fractures login to view 13 more bullets coracoid fractures login to view 13 more bullets complications Post-traumatic glenohumeral arthritis risk factors login to view 1 more bullet treatment login to view 3 more bullets Malunion risk factors login to view 3 more bullets treatment login to view 2 more bullets Recurrent glenohumeral instability risk factors login to view 2 more bullets treatment login to view 3 more bullets Neurovascular injury risk factors login to view 10 more bullets treatment login to view 4 more bullets