Scapula Fractures

Question 1

In trauma patients with multiple injuries, patients with scapula fractures have been shown to have an association with what, as compared to patients without scapula fractures?

Answer 1

Increased injury severity score; no difference in mortality, length of ICU stay, or overall hospital stay

Question 2

What is the most common associated injury with scapular fractures?

Answer 2

Rib fracture (40-50%)
Scapular fractures have 80-90% associated injuries including:
ipsilateral clavicle fracture (25%)
spine fracture (29%) 
brachial plexus injury (5%)
pneumothorax (32%)
pulmonary contusion (41%)
head injury (34%)
vascular injury (11%)

Question 3

What is the classification for glenoid fractures?

Answer 3

Ideberg:
I- fracture of the anterior/posterior glenoid rim
II- fracture through glenoid that exits inferiorly
III- fracture through the glenoid that exits superiorly
IV- fracture through the glenoid that exits medially
V- combo of IV and either II or III
VI- comminuted glenoid

Question 4

What are indications for surgical fixation of scapula fractures?

Answer 4

1) > 25% glenoid involvement
2) > 5mm of glenoid articular surface step off or major gap
3) excessive medialization of glenoid
4) scapula neck fx > 40° angulation or 1 cm displacement
5) open fracture
6) loss of rotator cuff function
7) coracoid fx with > 1cm of displacement

most scapula fx are treated non-op in sling for 2 weeks then progressive ROM

Question 5

What interval does the Judet approach to the scapula utilize?

Answer 5

Internervous plane btw infraspinatus (suprascapular n.) and teres minor (axillary n)