Scapula fractures

Scapula fractures = 1% of all fractures. Mean age 35-45 yrs.

Low incidence due to thick edges, mobility, recoil, muscular covering.

Biomech. force couple of normal shoulder abduction - RC vs Deltoid. RC stabalise humeral head on glenoid fossa. Displaced # glenoid fossa/neck disrupt couple, resulting in chronic abduction weakness and subacromial pain. 

Direct - Due to high energy trauma.

Indirect " axial load on outstretched arm

Causes:

•  R.T.A. - 60%
• Fall from height - 20%
• Others - 20%

Associated Injuries:

• Clavicle fractures 15 - 40%
• Rib fractures 25 - 50%
• Pulmonary injuries (heamo/pneumothorax, contusions)15 - 55%
• Humeral fractures 12%
• Brachial Plexus 5-10% 
• Skull fractures 25%
• C-spine # 12%
• Lower Limb fractures 11%
• Major Vascular injury 11%
• Splenic lacerations 8% 
•  Pelvic#/ intra-abdo injury

 P/C " pain, pseudorupture of RC, tenderness, ecchymosis, swelling, deformity

Imaging:

Xray: - true AP, axillary lateral, true scapular lateral, Stryker view(45deg cephalic tilt view)

CT: - 2D for glenoid fossa, neck#, 3D " complex patterns

EXTRA-ARTICULAR SCAPULA FRACTURES

Most can be managed non-operatively.

Zdravakovic classification (1974)

I " scapular body# : II " coracoid or acromial # : III " scapular neck or glenoid fossa #

Indications for surgery:

1. Depressed acromion fractures that encroach
   
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