Scapula fractures

Abstract

Over the past decade, there has been an increased interest in understanding the operative indications and techniques in treating scapular fractures and tracking their outcomes. Multiple studies have documented poor functional outcomes following nonoperative management of displaced scapular fractures. There is a groundswell of recognition that severe deformity from scapular malunion is associated with functional consequences for patients. This has led to a growing recognition that scapular fractures should be held to the same standards as other bodily fractures with regard to fracture fixation principles, including anatomic articular reduction, proper alignment, and stable internal fixation. Through research, there has been an improved understanding of scapular fracture patterns and the relevant surgical approaches and exposures used for fracture fixation. As with many bones, however, there still remains the absence of a compelling study that defines thresholds for surgical indication based on degrees of deformity and amounts of displacement.

Fig. 1

Management of scapula fractures. GPA = glenopolar angle; LBO = lateral border offset

Fig. 2

X-ray and 3-D reconstructed CT images illustrating displacement measurements described by Anavian et al. [•]. a, b Measurements of lateral border offset (yellow arrow) and glenopolar angle (blue angle), which are measured on the Grashey x-ray view and 3-D oriented in the true AP plane. c, d Measurements of translation (yellow arrow) and angulation (blue angle), which are measured on the scapula Y x-ray and 3-D CT views. e, f Intraarticular step-off and gap. These measurements can be performed on axial, sagittal, coronal, or 3-D CT reformats, depending on orientation of fracture line