Scapula Fracture

What is Scapula Fracture?

The first recorded instance of a shoulder fracture appeared in a book about bone fractures and dislocations written by P.J. Desault in 1805. Scapular fractures, or shoulder blade fractures, aren’t common, making up just 3-5% of all shoulder-related fractures and less than 1% of all fractures overall. These fractures often stem from serious injuries that affect multiple parts of the body, which is why it’s believed they’re so rare.

Studies show other injuries come along with 80-95% of shoulder blade fractures. Because of the severity of the injury required to break the shoulder blade and its correlation with other injuries, there’s often an increased risk of complications and even death. However, recent research has shed light on the fact that not all shoulder blade fractures carry the same risk. Specifically, scapular fractures that rank lower on the Injury Severity Score (ISS), a scale used to measure the severity of an injury, don’t have the same potential for complications or fatalities.

Traditionally, the treatment for shoulder blade fractures was conservative, and mainly involved non-surgical procedures. Today, consultation with an orthopedic trauma surgeon is common. This shift has occurred due to the advancements in surgical procedures which have helped improve patient recovery. Moreover, if the fracture has caused significant displacement, it can potentially lead to poor outcomes in the long run and may require more specialized care.

What Causes Scapula Fracture?

Around 80-90% of all fractures in the shoulder blade, or scapula, happen because of high-energy trauma. This can include things like car accidents, falls, and other heavy impacts. A direct hit can cause fractures anywhere in the scapula, while a strong blow to the top of the arm bone (the humerus) into the shoulder socket (glenoid fossa) often leads to fractures in the neck of the scapula and the socket.

Car accidents are responsible for over 70% of scapular fractures, with 52% connected to drivers and 18% involving pedestrians hit by cars. Other causes can include electric shocks and seizures due to the forces they put on the scapula. Fractures of only the scapula, with no other injuries, are pretty rare.

Risk Factors and Frequency for Scapula Fracture

Scapular fractures, or breaks in the shoulder blade, make up a small percentage of all fractures. They represent around 0.4-1% of total fractures, 3% of all shoulder fractures, and 5% of fractures that involve the shoulder girdle. These types of fractures are more commonly seen in younger males, specifically between the ages of 25 and 50, with a male to female ratio of 6:49. The most common locations for these fractures are in the body or the glenoid part of the scapula.

• Body of the scapula: 45% of fractures
• Glenoid Process (a part of the scapula that connects with the arm bone): 35% of fractures
• Acromion (the highest point of the shoulder): 8% of fractures
• Coracoid (a hook-like structure on the scapula): 7% of fractures

Signs and Symptoms of Scapula Fracture

A blow or a sharp injury directly to the shoulder blade is often the cause of scapula fractures. A physical examination and understanding the patient’s medical history can give doctors important information and help identify any related injuries that could be life-threatening. In cases of severe trauma, assessing the patient might not always be possible, especially if the patient’s mental state is affected. Evaluating the shoulder and upper part of the arm should be done in a way that allows for a good look at the back of the upper body. This can be quite challenging when a patient has multiple injuries and is lying down.

Differences in the position of the shoulder or upper arm bone might be clearly noticeable or quite subtle. Feeling and visually examining the bone structure should ideally be done, followed by a detailed examination of the nerves and blood vessels of the upper arm. Nerve damage in the network of nerves in the shoulder (brachial plexus) can occur in 5-13% of patients with shoulder blade fractures. Testing motor function can be tricky due to pain associated with these injuries. A comprehensive examination of the skin for open fractures is important because if the bone has punctured the skin, it requires immediate cleaning, removal of damaged tissue and antibiotics.

Testing for Scapula Fracture

If someone has fractured their scapula (shoulder blade), it usually means they’ve experienced a big impact because breaking this bone requires a lot of force. For this reason, if a person has a broken scapula, they likely have other injuries as well. It’s important in these cases that the individual is carefully checked over for other potential issues like breaks or tears in important veins and vessels found in the same area, which could be very dangerous.

To find these possible issues, the doctor will need to take some images of the injured area. They’ll usually start with X-rays from the front, side, and under the arm cases to get a clear picture of the broken bone. But, X-rays can often miss other injuries related to the fracture so a CT scan (which takes many X-rays from different angles to create a more detailed image) is also often suggested to check for other possible injuries.

If the joint is affected, an MRI scan (which uses a magnetic field to make detailed pictures of the inside of the body) may be required to look for damage to the ligaments (the tough, fibrous tissue that connects bones). Sometimes, the images from the CT scan can also be combined to form a 3D image of the injured area, which can help doctors work out the best way to treat the injury, and if surgery might be necessary.

Treatment Options for Scapula Fracture

Most shoulder blade fractures, or scapular fractures, can be effectively treated without surgery. In fact, over 90% of these fractures are minimally displaced (out of alignment), and only require short-term immobilization with a sling. It’s important for patients to start moving the shoulder as soon as they can to avoid it becoming stiff or “frozen”.

Scapular fractures rarely require emergency surgery, except for extreme situations like piercing of the chest area or dislocation that damages nearby blood vessels. However, considerably displaced fractures can lead to long-term complications and potentially poor shoulder function, hence such cases should be considered for surgery. It’s recommended to examine all scapular fractures for possible surgical treatment.

Surgery is advised if any of the following are significantly affected:

1. Scapula’s support systems, referred to as “Floating Shoulder”.
2. Open Fracture, when the bone has pierced the skin.
3. Integrity of the glenoid, the socket in the shoulder blade.
4. Displacement of the lateral column, on the outer edge of the shoulder blade.

Whether or not to perform open reduction and internal fixation, a common surgical procedure where the bones are put back into place and secured with special hardware, depends on specific features of the fracture. These include the location, how much the bones have moved or are angled, and whether the joint surface is uneven.

Surgery is suggested for fractures involving the shoulder joint if:

1. The joint surface is offset by more than 5mm.
2. The shoulder joint is unstable.
3. There’s a fracture at the front rim involving more than 25% of the joint surface.
4. There’s a fracture at the back rim involving more than one-third of the joint surface.

For fractures outside the joint, on the body and neck of the shoulder blade, surgery is suggested if:

1. There’s an angular deformity greater than 40 degrees.
2. There’s an offset on the outer border of more than 15mm with an angular deformity greater than 35 degrees.
3. There’s an offset of the outer border of more than 20mm.
4. The angle between the shoulder joint and the tip of the shoulder blade is less than 22 degrees on a particular X-ray view.

However, it’s important to note that because scapular fractures often occur alongside other serious injuries, any surgery should be postponed until the patient’s overall condition is stable.

What else can Scapula Fracture be?

• Stomach Pain in Older People
• Injury to the Joint That Connects the Shoulder to the Collarbone
• Broken Collarbone
• Non-Specific Lower Back Pain
• Collapsed Lung
• Broken Rib
• Displaced Shoulder

What to expect with Scapula Fracture

Fractures that do not require surgery and are managed carefully have been found to have good to excellent results in terms of functionality 86% of the time. Less than 1% of fractures actually require surgical treatment, but research shows that these patients also have excellent functional outcomes.

Recovery typically involves six weeks of active and assisted movement; strength training usually starts about 3-4 months after the injury or surgery. Patients with fractures that did not require surgery can often expect virtually no negative impacts on their ability to function, and good to excellent results in their ability to function are also seen in fractures requiring surgical treatment.