scapular fractures

Question 1

what is the cause of scapular fractures?

Answer 1

high energy trauma

Question 2

what is the classification of scapular fractures ?

Answer 2

according to location

acromial fracture

coracoid fracture

interarticular glenoid fracture

extra articular glenoid fracture = scapular neck fracture (with clavicular fracture)

Question 3

how is the acromial scapular fracture classified ?

Answer 3

type 1 - non displaced and minimally displaced (avulsion fractures / complete fracture)
= non operative

type2 - displaced but does not reduce the subacromial space = non operative

type 3 - inferior displacement of acromion process and goes into the subacromial space or
=operative

Question 4

if there is type 3 acromial fracture how do we operatively treat it ?

Answer 4

inferior displacement - open reduction and internal fixation by cannulated screw or plate fixation

for superiorly displaced glenoid neck we do open reduction and plate fixation

Question 5

what s the classification of the coracoid fracture ?

Answer 5

type 1 - where the fracture is proximal to the coracoclavicular lig ,
associated with acromiaoclavicular separation or clavicular fractures

type 2 - fracture is distal to coracoclavicular lig - tip of coracoid
no surgical treatment - sling ?

Question 6

how is type 1 coracoid fracture operatively treated

Answer 6

internal reduction and fixation screws

Question 7

classification of interarticular glenoid fractures

Answer 7

IDEBERG classification

type 1a - anterior rim = no surgical treatment

type 1b - posteriori rim = no surgical treatment

==== operative====

type 2 - fracture line through glenoid fossa exiting scapula laterally
triangular fragment displaced
with subluxation of subluxation of humeral head
=operation

type 3- fracture line through glenoid fossa exiting the scapula superior

type 4 - exiting the glenoid fossa medially

type 5a - type 2 and and type 4 combo

type 5b - type 3 and type 4

type 5c - type 2,3,and 4

type 6 - severe communition

Question 8

indications for interarticular glenoid fractures to be treated non operatively ?

Answer 8

indicated for vast majority of scapula fractures

90% are minimally displaced and acceptably aligned

Question 9

technique for non operative treatment for interarticular glenoid fractures

Answer 9

sling for 2 weeks, followed by early motion

Question 10

indications for operative procedure in scapular fracture ?

Answer 10

glenohumeral instability
> 25% glenoid involvement with subluxation of humerus
> 5mm of glenoid articular surface step off or major gap

==

displaced scapula neck fx
with 
> 40 degrees angulation or 1 cm translation
excessive medialization of glenoid
==
open fracture

===
loss of rotator cuff function

==

coracoid fx with > 1cm of displacement

Question 11

what approach can be taken for open reduction and internal fixation of scapula ?

Answer 11

based on fracture location

anterior approach for anterior glenoid rim fracture
fracture of the anterior inferior glenoid = BONY BANKART FRACTURE (avoid injury to axillary nerve )

=======
most common

Judet approach is most common
utilizes internervous plane between infraspinatus (suprascapular nerve) and teres minor (axillary nerve)

posterior glenoid rim fracture
lateral border
scapular neck

Question 12

how is type 2 interarticular glenoid fractures treated ?

Answer 12

open reduction and internal fixation with a plate or a screw on the lateroinferior aspect of the glenoid fossa

Question 13

how do we treate type 4 of intraarticular glenoid fracture

Answer 13

open reduction and internal fixation with screws

Question 14

how do we treat type 5 of intraartciualr glenoid fracture ?

Answer 14

open reduction and internal fixation by screws

Question 15

what are the complication of the judder approach in ORIF?

Answer 15

increased traction of the infraspinatus muscle = injury to supra scapular nerve

Question 16

what is the classification for extra articular glenoid fracture ?

Answer 16

type 1 -fracture of the glenoid neck without association of clavicular fracture or acromioclavicular joint involvement

type 2 - fracture of the glenoid neck with clavicular fracture and AC joint separation
involvement superior shoulder suspensory ligaments = floating shoulder

Question 17

hw do we treat extraarticular glenoid fracture ?

Answer 17

type 1 - sling
if meeting criteria
open reduction and internal plate fixation of the fractures in the lateroinferioir part of the scapular (inferior to glenoid fossa)

type 2 - sling
meeting criteria of both clavicle and scapula ?
open reduction with internal fixation using scapular and clavicular plating

Question 18

Associated injuries with scapular fractures ?

Answer 18

orthopaedic
rib fractures (52%)
ipsilateral clavicle fracture (25%)
spine fracture (29%)

medical
pulmonary injury
pneumothorax (32%)
pulmonary contusion (41%)

Question 19

In trauma patients with multiple injuries, patients with scapula fractures have been shown to have an association with which of the following, as compared to patients without scapula fractures?

Answer 19

increased injury severity score

2-5% associated mortality rate