scapular fractures Flashcards
what is the cause of scapular fractures?
high energy trauma
what is the classification of scapular fractures ?
according to location
acromial fracture
coracoid fracture
interarticular glenoid fracture
extra articular glenoid fracture = scapular neck fracture (with clavicular fracture)
how is the acromial scapular fracture classified ?
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
if there is type 3 acromial fracture how do we operatively treat it ?
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
what s the classification of the coracoid fracture ?
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 ?
how is type 1 coracoid fracture operatively treated
internal reduction and fixation screws
classification of interarticular glenoid fractures
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
indications for interarticular glenoid fractures to be treated non operatively ?
indicated for vast majority of scapula fractures
90% are minimally displaced and acceptably aligned
technique for non operative treatment for interarticular glenoid fractures
sling for 2 weeks, followed by early motion
indications for operative procedure in scapular fracture ?
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
what approach can be taken for open reduction and internal fixation of scapula ?
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
how is type 2 interarticular glenoid fractures treated ?
open reduction and internal fixation with a plate or a screw on the lateroinferior aspect of the glenoid fossa
how do we treate type 4 of intraarticular glenoid fracture
open reduction and internal fixation with screws
how do we treat type 5 of intraartciualr glenoid fracture ?
open reduction and internal fixation by screws
what are the complication of the judder approach in ORIF?
increased traction of the infraspinatus muscle = injury to supra scapular nerve
what is the classification for extra articular glenoid fracture ?
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
hw do we treat extraarticular glenoid fracture ?
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
Associated injuries with scapular fractures ?
orthopaedic
rib fractures (52%)
ipsilateral clavicle fracture (25%)
spine fracture (29%)
medical
pulmonary injury
pneumothorax (32%)
pulmonary contusion (41%)
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?
increased injury severity score
2-5% associated mortality rate
