[Fractures of the scapula]

Abstract

Two thirds of the fractures of the scapula refer to its body, one third to its neck, and one forth to the glenoid. They are indicative of high-energy blunt trauma. Traffic injuries are their main cause. Associated ipsilateral upper torso injuries are common and have to be considered!Scapular fractures may be classified as being extra- or intraarticular. Extraarticular fractures concern the scapular body, its processes, or the scapular neck. A fracture of the surgical neck of the scapula accompanied by an injury to the coracoclavicular connection is regarded as a "floating shoulder". In this case the broken suspension of the glenoid has to be reconstructed. Most intraarticular fractures are of the Bankart variety, where a shoulder dislocation spreads an oblique fragment of the glenoid. They should be treated by internal fixation, if the size of the fragment is bigger than 16 mm. Where surgery is advisable, an appropriate approach has to be chosen depending on the type of the fracture. The anterior approach of Neer and the dorsolateral approach of Brodsky are very suitable. As a basic principle dislocated or unstable fractures of the scapular processes and of the glenoid should be treated by internal fixation, since their functional result may be less than fair if they are treated conservatively. Most other fractures heal uneventful under a conservative regimen.