Fracture of the scapular neck combined with rotator cuff tear: A case report

Abstract

Background: Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of all fractures, and scapular neck fractures are extremely rare, comprising approximately 7%-25% of all scapular fractures. Scapular neck fractures are often studied as case reports mostly accompanied by other injuries, thus leading to confusion. All previous cases of scapular neck fractures are not associated with rotator cuff injuries.

Case summary: A 62-year-old man was admitted to our emergency department 6 h after his right shoulder and back were impacted by heavy objects. The patient presented chest tightness and shortness of breath. Chest computed tomography (CT) showed pneumohemothorax, multiple rib fractures, and right scapula fractures. Three-dimensional CT reconstruction of the right shoulder joint showed a trans-spinous scapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injury was suspected because the patient had a glenohumeral joint dislocation and was then confirmed by shoulder magnetic resonance imaging. A staged surgery was performed, including open reduction and internal fixation of the right scapula fracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mo follow-up, the fracture line was blurred and the shoulder joint function was good.

Conclusion: Fracture of the scapular neck combined with rotator cuff tear is rare and the rotator cuff injury should not be ignored in clinical work. Stable internal fixation combined with secondary arthroscopic repair of rotator cuff tear can achieve good results.

Keywords: Case report; Glenohumeral dislocation; Rotator cuff tear; Scapular fractures; Scapular neck fractures.

Figure 1

Computed tomography of the right shoulder joint. A: Posterior view of three-dimensional (3D) reconstruction; B: Anterior view of 3D reconstruction; C: Axial computed tomography image showing trans-spinous scapular neck fracture accompanied with glenohumeral joint dislocation.

Figure 2

Magnetic resonance imaging of the right shoulder. A: Coronal T2 fat-suppressed image; B: Axial T2 fat-suppressed image showing a full-thickness tear of supraspinatus, infraspinatus subscapularis tendons, and interposition of long head bicep tendon. The orange arrow indicates supraspinatus tendon, and the yellow arrow indicates subscapularis tendons. H: Humeral head; D: Deltoid muscle; Asterisk: Long head bicep tendon.

Figure 3

Dislocation of the glenohumeral joint after open reduction and internal fixation of the scapular neck fracture. A: Anterior-posterior X-ray; B: Three-dimensional reconstruction; C: Axial computed tomography image showing anatomical reduction of the scapula and glenohumeral joint dislocation.

Figure 4

Anterior-posterior X-ray image showing glenohumeral reduction. The rotator cuff repair was performed with poly-ether-ether-ketone suture anchors. Hence, no apparent results were observed in the X-ray.

Figure 5

Anterior-posterior X-ray image showing a small translucent shadow on the lateral margin and that the fracture line is blurred.