Scapula Fractures - Trauma

Introduction

Uncommon fracture pattern associated with high energy trauma
- 2-5% associated mortality rate
  - usually pulmonary or head injury
  - associated with Increased Injury Severity Scores
Epidemiology
- incidence
  - less than 1% of all fractures
- location
  - 50% involve body and spine
Associated injuries (in 80-90%)
- orthopaedic
  - rib fractures (52%)
  - ipsilateral clavicle fracture (25%)
  - spine fracture (29%)
  - brachial plexus injury (5%)
    - 75% of brachial plexus injuries resolve
- medical
  - pulmonary injury
  - pneumothorax (32%)
  - pulmonary contusion (41%)
  - head injury (34%)
  - vascular injury (11%)

Classification

Coracoid Fracture Classification
Type I	Fracture occurs proximal to the coracoclavicular ligament
Type II	Fracture occurs towards the tip of the coracoid

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 laterally
Type III	Fracture line through glenoid fossa exiting scapula superiorly
Type IV	Fracture line through glenoid fossa exiting scapula medially
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

Imaging

Radiographs
- recommended views
  - true AP, scapular Y and axillary lateral view
CT
- intra-articular fracture
- significant displacement
- three-dimensional reconstruction useful

Treatment

Surgical Technqiues

Open Reduction Internal Fixation of Scapula
- approach
  - based on fracture location
  - Judet approach is most common
    - utilizes internervous plane between infraspinatus (suprascapular nerve) and teres minor (axillary nerve)