Scapula fractures

Question 1

What is the origin of the biceps brachii muscle?

Answer 1

The supraglenoid tuberosity

Question 2

What is the origin of the acromial head of the deltoideus muscle?

Answer 2

Acromium

Question 3

What nerves are closely associated with the scapula?

Answer 3

Suprascapular (wraps distally around the scapular spine deep the acromium), axillary (caudal scapulohumeral joint)

Question 4

What occurs with damage to the suprascapular nerve?

Answer 4

Infraspinatous and supraspinatous atrophy

Question 5

What are the classification systems used for scapular fracture?

Answer 5

Traditional:
1 - body and spine
2 - neck
3 - glenoid

Cook et al:
1. Extraarticular stable
2. Extraarticular unstable
3. Intraarticular

Question 6

Which scapular fractures should be repaired?

Answer 6

Extraarticular unstable and intraarticular

Question 7

What are common extraarticular unstable fractures of the scapula?

Answer 7

Scapula neck, acromium, unstable overriding body fractures

Question 8

Where is bone depth greatest in the scapula spine?

Answer 8

Cranially it is deepest distally, and caudally it is deepest proximally

Question 9

How can scapula body fractures be repaired?

Answer 9

Interfragmentary wire, plating

Question 10

How can acromial fractures be repaired?

Answer 10

K-wires and figure of 8, interfragmentary wiring

Question 11

How can scapula neck fractures be repaired?

Answer 11

Cross-pinning (normal or divergent), plating

Question 12

How can supraglenoid tuberosity or glenoid fractures be repaired?

Answer 12

Supraglenoid tuberosity: K-wires and tension band.
Highly comminuted: consider glenoid excision

Question 13

How can glenoid fractures be repaired?

Answer 13

Glenoid T-Y: Lag screw should be placed cranial-caudal to stabilize articular component, followed by plating of the neck.

Question 14

How can scapula luxation be repaired?

Answer 14

Wiring of the scapula to the 5th, 6th, or 7th rib. Augmentation with Velpeau sling. Prognosis is excellent.

Question 15

Can ununited accessory ossification center of the caudal glenoid result in lameness?

Answer 15

Yes, has been reported if unstable. Typically resolves with removal.

Question 16

In a study by Kulendra 2019 in VCOT, what methods of repair were reported for supraglenoid tubercle fractures? What factor was associated with a higher rate of complications?

Answer 16

Pin and TBW, lag screw, plate fixation, fragment removal, and conservative management.

Comminution was associated with an increased risk of complications.

Question 17

What are the two ways that fractures of the supraglenoid tubercle can be approached?

Answer 17

Either via osteotomy of the greater tubercle of the humerus or by splitting the supraspintous muscle. Splitting of the muscle may be preferred in juvenile patients to avoid growth plate disruption.