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:

• clavicle fracture
• rib fracture
• sternal fracture
• spinal fracture
• pneumothorax and/or pulmonary contusion
• brachial plexus injury

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:

• true anterior-posterior view of the scapula
• lateral view
• axillary view

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

• os acromiale and other accessory ossicles of the scapula

Siehe auch:

• Battered-Child-Syndrom
• Glenoidfraktur
• Akromionfraktur
• Fraktur Processus coracoideus

und weiter:

• Scapula
• Klassifikation Glenoidfraktur nach Ideberg