Scapular Fractures, types and treatment - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes scapular fractures and scapular fractures surgery .
Scapular fractures are typically a high energy injuries with an increase in the injury severity score (ISS).
50% of scapular fractures involve the body and the spine of the scapula.
10% of scapular fractures involve the glenoid fossa.
Associated Condition:
• 80-70% occur with associated injury.
There is a high association with rib fractures.
Head injury
• Head injury
• Ipsilateral upper rxtremiy injury
• Pulmonary contusion ‘pneumothorax
• Hemopneomothorax
Isolated scapular injury is really s marker for injury to the chest region .
Need to admit these patients for the pulmonary consultation, there is about 10% neurovascular deficit occurs in about 10%, injury to the scapula can be n=mii
90% of the fractures involving the scapula are nondisplaced or minimally displaced, and the treatment of these fractures is usually nonsurgical.
Most scapular fractures are treated conservatively.
Even if the fracture was moderately, treat conservatively y, treat the patient with a sling.
Patient with a sling, do Codman pendulum exercises for 2 weeks and then advice the patient to do active and passive range of motion.
Classifications of scapular fracture: based on the fracture location:
Extraarticular fractures:
1- Acromial fracture: fracture will probably need surgery.
2- Coracoid fracture: occurs proximal to the CC ligament, it is usually associated with other injuries to the superior shoulder suspensory complex (SSSC) and it may need surgery.
3- Scapular neck fracture/ Clavicle fracture: management of these fractures is controversial; most of them are treated conservatively, even if the fracture is moderately displaced.
Treatment:
Most of the treatment is sling and early range of motion.
Give the patient a sling
Send the patient to therapy
Do progressive range of motion.
Union of the fracture will occur in about 6 seeks with little or no functional deficit.
Surgical indication:
The goal of the surgery: treatment is to achieve shoulder joint stability and to restore the rotator cuff function.
Do surgery when there is involvement of the glenoid cavity more than 25% with humeral head subluxation.
Or if you have intraarticular fracture with step- off more than 5 mm gap within the joint.
For the neck of the scapula: do surgery if there is more than 40° of angulation, more than 1 cm of translation or if there is excessive medialization of the glenoid.
What is the approach you use???
The approach is based on the major fracture fragment displacement.
• Anterior approach for anterior rim fracture
Such as bony Bankart fracture: fracture of the anterior- inferior glenoid.
Avoid injury to the axillary nerve.
• Posterior approach:
Is usually done through straight posterior approach or a modified judet approach.
The straight posterior approach is used through a transverse incision over the spine of the scapula and you detach the posterior deltoid, entering through an interval between the teres minor and the infraspinatus muscles, this approach is used for posterior glenoid rim fractures or for fractures along the lateral boarder of the scapula.
Injury to the posterior shoulder suspensory complex:
Some people call that injury the floating shoulder because the glenohumeral joint is without attachment to the rest of the skeleton and others refer to this injury as a SSSC injury.
You need to decide if that injury is stable or unstable, unstable injury will probably need surgery.
Typically it is a scapular neck fracture plus clavicle fracture and because to plate the clavicle than to fix the scapula, then in the past the treatment of the floating shoulder was: ORIF (open reduction, internal fixation) of the clavicle then evaluate the scapular fracture usually by a CT scan, but they found that the sling equivalent outcome or even a superior outcome to preforming surgery.
So there was no support for surgery, they came to the conclusion that surgical stabilization only needed with specific indications to that fracture, it means: if the clavicle fracture meets the criteria for fixation, then fix it, if the glenoid meets the criteria for fixation, then fix it.
Scapulothorasic dissociation:
Is another injury of the scapula, it’s a lateral displacement of the scapula and soft tissue injury with neurovascular injury; it is similar to a closed forequarter amputation.
The scapula is torn and moves laterally, when it moves laterally, there may be a fractured clavicle distracted or AC joint injury or sternoclavicular injury.
The x-ray will show you the lateral displacement of the scapula, check the patient carefully, the subclavianartery and the brachial plexus could be injured, and the brachial plexus is torn first before the artery, so there is more brachial plexus injury than the arterial injury.
The outcome for the patient will depend on the neurological status of the patient.