Scapula Fracture

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SCAPULA FRACTURE

DR JASEEM SHAMSUDEEN


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EPIDEMIOLOGY

Relatively uncommon injury

Only 3% to 5% of all soul!er fractures an!"#5% to $% of all fractures#

e mean a&e of 'atients 35 to (5 years


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ANATOMY


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ANATOMY


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)lat* trian&ular +one lin,s te u''er e-tremity

to te a-ial s,eleton# .rotection from im'act is 'rovi!e! +y te

lar&e surroun!in& muscle mass as /ell as

te mo+ility of te sca'ula on te cest /all*

furter ai!in& in force !issi'ation


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MECHANISM OF INJURY

0ommon cause of injury RA

1n!irect injury occurs trou& a-ial loa!in& on te outstretce!arm 2sca'ular nec,* &lenoi!* intraarticular fracture#

Direct trauma* often i& ener&y* occurs from a +lo/ or fall2sca'ula +o!y fracture or trou& !irect trauma to te 'oint of

te soul!er 2acromion* coracoi! fracture#

Soul!er !islocation may cause a &lenoi! fracture#

Muscles or li&aments may cause an avulsion fracture


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CLINICAL EVALUATION

A full trauma evaluation

Neurovascular assessment# 0om'artment syn!rome overlyin& te sca'ula is

uncommon

0omolli si&n is trian&ular s/ellin& of te 'osterior

tora- overlyin& te sca'ula an! is su&&estive ofematoma resultin& in increase! com'artment

'ressures#


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RADIOGRAPHIC EVALUATION

rauma series of te soul!er* Antero'osterior vie/*

A-illary vie/* Sca'ular89 vie/ 2true sca'ular lateral: e a-illary vie/ may +e use! to !elineate acromial an! &lenoi! rim

fractures furter# A (58!e&ree ce'alic tilt 2Stry,er notc ra!io&ra' is el'ful to i!entify

coracoi! fractures

An acromial fracture soul! not +e confuse! /it an os acromiale*/ic is a roun!e!* unfuse! a'o'ysis an! is 'resent in a''ro-imately3% of te 'o'ulation# ;en 'resent* it is +ilateral in 7"% of cases#

Glenoi !"#o#lasia* or sca'ular nec, !ys'lasia* is an unusuala+normality tat may resem+le &lenoi! im'action an! may +eassociate! /it umeral ea! or acromial a+normalities# 1t as a+eni&n course an! is usually note! inci!entally#

0


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CLASSIFICATION

Anatomic 0lassification 2>!rav,ovic an! Damolt

2A Sca'ula +o!y

2?*0 @lenoi!

2D Sca'ula nec,

2E Acromion2) Sca'ula s'ine

2@ 0oracoi!#


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ANATOMICAL CLASSIFICATION

T"#e I$Sca'ula +o!y

T"#e II$ A'o'yseal fractures* inclu!in& teacromion an! coracoi!

T"#e III$)ractures of te su'erolateral an&le*

inclu!in& te sca'ular nec, an! &lenoi!


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Ie%er& Classi'ica(ion o' In(raar(ic)lar

Glenoi Frac()res

y'e 14Avulsion fracture of te anterior mar&in y'e 11A4ransverse fracture trou& te &lenoi!

fossa e-itin& inferiorly y'e 11?4O+liue fracture trou& te &lenoi! fossa

e-itin& inferiorly y'e 1114O+liue fracture trou& te &lenoi! e-itin&

su'eriorly an! often associate! /it anacromioclavicular joint injuryy'e 1B4ransverse fracture e-itin& trou& te me!ial

+or!er of te sca'ula y'e B40om+ination of a ty'e 11 an! ty'e 1B 'attern y'e B140omminute! &lenoi! fracture


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Classi'ica(ion o' Acromial Frac()res

y'e 14Minimally !is'lace!

y'e 114Dis'lace! +ut !oes not re!uce tesu+acromial s'ace

y'e 1114Dis'lace! /it narro/in& of te

su+acromial s'ace


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Classi'ica(ion o' Coracoi Frac()res

y'e 14.ro-imal to te coracoclavicular

li&ament# y'e 114Distal to te coracoclavicular li&ament


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TREATMENT

Nono'erative

Most sca'ula fractures are amena+le tonono'erative treatment* consistin& of slin&

use an! early ran&e of soul!er motion#


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OPERATIVE INDICATIONS

$# Dis'lace! intraarticular &lenoi! fractures involvin&&reater tan 5% of te articular surface#

# Sca'ular nec, fractures /it &reater tan ("8!e&reean&ulation or $8cm me!ial translation#

3# Sca'ular nec, fractures /it an associate!!is'lace! clavicle fracture#

(# )ractures of te acromion tat im'in&e on te

su+acromial s'ace#5# )ractures of te coracoi! 'rocess tat result in a

functional acromioclavicular se'aration#

7# 0omminute! fractures of te sca'ular s'ine#


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Glenoi 'rac()res *Ie%er&

classi'ica(ion+$

T"#e I$)ractures involvin& &reater tan one fourt of te&lenoi! fossa tat result in insta+ility may +e amena+le to o'en

re!uction an! internal fi-ation /it scre/ fi-ation usin& ananterior or 'osterior a''roac# T"#e II$1nferior su+lu-ation of te umeral ea! may result*

necessitatin& o'en re!uction* es'ecially /en associate! /ita &reater tan 58mm articular ste'8off# An anterior a''roacty'ically 'rovi!es a!euate e-'osure

#T"#e III$Re!uction is often !ifficult an! may reuire su'eriore-'osure for su'erior to inferior scre/ 'lacement* 'artial8tic,ness clavicle removal* or !istal clavicle resection ina!!ition to anterior e-'osure for re!uction# A!!itionalsta+iliCation of te su'erior sus'ensory soul!er com'le-2SSS0 may +e necessary


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Sca'ular +o!y fractures4 Nono'erative O'en re!uction may +e consi!ere! /en neurovascular

com'romise is 'resent an! e-'loration is reuire!# @lenoi! nec, fractures4 ese &enerally may +e treate!

sym'tomatically* /it early ran&e8of8motion e-ercises# 1f te injury is accom'anie! +y a !is'lace! clavicle fracture* an

unsta+le se&ment may e-ist* inclu!in& te &lenoi!* acromion*an! lateral clavicle# 1nternal fi-ation of te clavicular fracture&enerally results in a!euate sta+iliCation for ealin& of te&lenoi! fracture#


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Acromion fractures4 Os acromiale must first +e rule!out* as /ell as concomitant rotator cuff injuries#

Dis'lace! acromion fractures may +e sta+iliCe! +y!orsal tension +an!in&* if !is'lacement causessu+acromial im'in&ement#

0oracoi! fractures4 0om'lete tir!8!e&reeacromioclavicular se'aration accom'anie! +y asi&nificantly !is'lace! coracoi! fracture is anin!ication for o'en re!uction an! internal fi-ation of+ot injuries#


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Floa(in& s!o)ler$

Dou+le !isru'tions of te su'erior soul!er

sus'ensory com'le- 2SSS0#

e SSS0 is a +one8soft tissue rin& tat inclu!es te&lenoi! 'rocess* coracoi! 'rocess* coracoclavicular

li&aments* !istal clavicle* acromioclavicular joint* an!

acromial 'rocess#

e su'erior strut is te mi!!le tir! clavicle#e inferior strut is te lateral sca'ular +o!y an!

s'ine#


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raumatic !isru'tion of t/o or more

com'onents of te SSS0 usually secon!aryto i&8ener&y injury is freuently !escri+e!

as a floatin& soul!er#


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Floa(in& s!o)ler in,)r" #a((erns

P)rel" osseo)s in,)ries4 y'e 1A4 sca'ular nec, fracture com+ine! /it a coracoi! +ase

fracture# y'e 1?4 sca'ular nec, fracture com+ine! /it a clavicle fracture an!

sca'ular s'ine or acromion fracture#

P)rel" li&amen(o)s in,)r" y'e 114 sca'ular nec, fracture com+ine! /it coracoacromial an!

coracoclavicular li&ament !isru'tion#

Com%ine osseoli&amen(o)s in,)ries

y'e 111A4 sca'ular nec, fracture com+ine! /it a clavicular saftfracture 'lus coracoacromial an! acromioclavicular li&ament!isru'tion#

y'e 111?4 sca'ular nec, fracture com+ine! /it an acromion orsca'ular s'ine fracture 'lus coracoclavicular an! acromioclavicularli&ament !isru'tion#

American Aca!emy of Orto'ae!ic Sur&eons


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TREATMENT

O'erative mana&ement as +een

recommen!e! +ecause of 'otential insta+ilityan! !is'lacement of te &lenoi!#

Recent series of nono'erative treatment of

floatin& soul!ers re'orte! &oo! results#


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COMPLICATIONS

Associate! injuries4 Most serious com'lication#

1ncrease! mortality is associate! /it concomitant

first ri+ fracture#

Malunion4 .ainful sca'ulotoracic cre'itus#

Nonunion4 is is e-tremely rare* +ut /en 'resent

an! sym'tomatic it may reuire o'en re!uction an!

internal fi-ation#

Su'rasca'ular nerve injury4 is may occur in

association /it sca'ula +o!y* nec,* or coracoi!

fractures tat involve te su'rasca'ular notc#


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Scapula Fracture

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