scapular fracture

Scapula fractures are uncommon injuries, representing ~3% of all shoulder fractures.

Pathology

Mechanisms of injury
  • requires high energy trauma (e.g. motor vehicle accidents account for 50% of scapular fractures)
  • direct trauma to the shoulder region
  • indirect trauma through falling on outstretched hand
  • non-accidental injuries in children
Associations

Scapular fractures are often associated with other injuries:

Radiographic features

Plain radiograph

Requires trauma series views to demonstrate the fractures due to the superimposition of the shoulder girdle and thoracic cage.

Radiographic series includes:

CT
  • standard for diagnosis and evaluation of the fracture and its associated injuries
  • axial scan with coronal, sagittal and 3D reconstructions are used in the assessment of scapular injuries

Classification

  • intra-articular glenoid fracture
    • type I: avulsion of anterior glenoid margin
    • type II: transverse or oblique fracture through glenoid fossa exiting inferiorly
    • type III: oblique fracture through glenoid fossa exiting superiorly and associated with acromioclavicular joint injury
    • type IV: transverse fracture exiting through the medial scapular border
    • type V: combination of type II and type IV
    • type VI: comminuted glenoid fracture
  • extra-articular glenoid fracture
    • type I: glenoid neck fracture without clavicular fracture
    • type II: glenoid neck fracture with clavicular fracture and acromioclavicular dislocation
  • coracoid process fracture
    • type I: fracture proximal to the coracoclavicular ligament
    • type II: fracture distal to the coracoclavicular ligament
  • acromial fracture
    • type I: minimally displaced
    • type II: displaced but does not reduce subacromial space
    • type III: displaced and narrow the subacromial space

Differential diagnosis

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