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 Classification is based on the location of the fracture and includes coracoid fractures acromial fractures glenoid fractures scapular neck fractures look for associated AC joint separation or clavicle fracture known as "floating shoulder" scapular body fractures described based on anatomic location scapulothoracic dissociation 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 Nonoperative sling for 2 weeks, followed by early motion indications indicated for vast majority of scapula fractures 90% are minimally displaced and acceptably aligned outcomes union at 6 weeks can expect no functional deficits Operative open reduction internal fixation indications glenohumeral instability > 25% glenoid involvement with subluxation of humerus > 5mm of glenoid articular surface step off or major gap excessive medialization of glenoid displaced scapula neck fx with > 40 degrees angulation or 1 cm translation open fracture loss of rotator cuff function coracoid fx with > 1cm of displacement outcomes 70% good to excellent results with operative 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)
CPT Only CPT Codes: 23585 Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Open treatment of scapular fracture (body, glenoid or acromion) Team Orthobullets (D) Trauma - Scapula Fractures
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.134) The modified Judet approach to the posterior scapula exploits the internervous interval between what two muscles? Review Topic QID: 520 1 Supraspinatus and infraspinatus 7% (146/2221) 2 Supraspinatus and subscapularis 2% (40/2221) 3 Infraspinatus and teres minor 86% (1900/2221) 4 Teres minor and teres major 3% (58/2221) 5 Teres major and lattisimus 3% (64/2221) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.122) A patient sustains a displaced scapular neck fracture. What is the internervous plane for a posterior approach to the glenohumeral joint? Review Topic QID: 783 1 Lateral pectoral-axillary 1% (7/485) 2 Subscapular-musculocutaneous 1% (6/485) 3 Suprascapular-axillary 85% (412/485) 4 Long thoracic-spinal accessory 3% (13/485) 5 Suprascapular-subscapular 7% (35/485) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (OBQ06.159) 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? Review Topic QID: 345 FIGURES: A 1 Immobilization in sling x 2 weeks then PT 56% (599/1067) 2 Immobilization in sling x 8 weeks then PT 6% (64/1067) 3 ORIF via a deltopectoral approach 6% (63/1067) 4 ORIF via a posterior approach 31% (332/1067) 5 ORIF via a lateral approach 0% (3/1067) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ06.266) In trauma patients with multiple injuries, patients with scapula fractures have been shown to have an association with which of the following, as compared to patients without scapula fractures? Review Topic QID: 277 1 Increased length of hospital stay 4% (33/808) 2 Increased mortality rate 18% (145/808) 3 Increased rate of extremity fracture(s) 6% (52/808) 4 Increased Injury Severity Scores 60% (483/808) 5 Increased length of intensive care unit stay 11% (87/808) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 4
Upgrade to View Premium Videos Upgrade to View Premium Videos Scapular Fracture Classification Animation - Everything You Need To Know - Dr. Nabil Ebraheim Derek Moore General - Scapula Fractures 8/13/2012 6561 views
Scapular Fracture in a 24M following MVC (C2767) Trauma - Scapula Fractures HPI - RTA - 2 wheeler rider collided with a stationary vehicle - closed fracture of the left clavicle, scapula and left multiple rib fractures with haemopneumothorax - haemodynamically stable. Normal neurovascular examination of the upper limb. Other injuries - L3 wedge #, Left iliac crest fracture. How would you manage the scapular fracture? 2/20/2017 344 9 6 scapular fracture (C2611) Trauma - Scapula Fractures HPI - RTA - 2 wheeler rider - fall onto right outstretched hand - painful right shoulder movements - closed injury - neurovascularly intact How would you classify this scapula fracture? 6/20/2016 576 8 3 Highly comminuted scapular fracture (C2464) Trauma - Scapula Fractures HPI - This unfortunate 28 year-old-male was shot by a machine gun in September 2014 in the Libyan civil war and sustained this isolated injury. No surgical intervention was performed at that time. How would you classify the scapula fracture? 12/20/2015 490 2 6 See More See Less