Case report of an unusual extra-articular scapular malunion: Rare indication for surgery

Abstract

Introduction: Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention.

Patient and clinical history: A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall.

Surgical technique: Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization.

Results: The patient's symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur.

Discussion: This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.

Keywords: Impingement; malunion; scapula.

Figure 1.

Pre-operative 3D CT scans showing the scapula malunion impinging upon the ribs.

Figure 2.

Intra-operative images of the approach below the scapular spine, the minimally invasive bony dissection at the base of the malunited bone spike and the removal of spike.

Figure 3.

3D model with removed bone indicating the position of the bony malunion.

Figure 4.

Clinical images of post-operative range of motion.