Makindo Medical Notes

🦴 Scapula fractures are uncommon due to the bone’s protection by surrounding muscles and chest wall. ⚠️ When present, they are often associated with chest wall trauma and underlying pulmonary injury.

ℹ️ About

• 📉 Isolated scapula fractures are rare.
• 👴 More common in frail elderly patients after falls.
• 💥 In younger patients, usually due to high-energy trauma (RTAs, falls from height).

📍 Injury Sites

• 🏹 Glenoid cavity
• 🔗 Glenoid neck
• 📐 Acromion
• 🪝 Coracoid process
• 🪶 Scapular blade (usually minimally displaced)

⚡ Typical Mechanism

• 🚗 High-energy trauma (direct blow to shoulder/back)
• 🪂 Falls (e.g. down stairs) → scapular blade fractures
• 🔎 Always consider associated rib fractures, pneumothorax, or pulmonary contusion

⚠️ Pitfalls & Complications

• 🔩 Glenoid or glenoid neck fractures may require surgical fixation
• ⚡ Nerve injury (esp. suprascapular or long thoracic nerve)
• 🫁 Associated chest trauma → rib fractures, pneumothorax, haemothorax
• 🪽 Winging of the scapula → indicates long thoracic nerve injury (serratus anterior palsy)

🔎 Investigations

• 🩻 Request a scapula X-ray (AP, lateral, axillary views if possible)
• 🖥️ Consider CT if fracture extends into the glenoid or if surgical planning required
• 🫁 Chest X-ray/CT if associated thoracic injury suspected

💊 Management

• 🫁 Ensure satisfactory respiratory examination & observations (exclude pneumothorax/haemothorax)
• 🩹 Broad-arm sling, analgesia, and early mobilisation to prevent stiffness
• 🏥 Refer to orthopaedics ± CT → many will need fracture clinic follow-up
• 🪽 Assess/document scapular winging → outpatient ortho follow-up needed if present

📌 Exam Pearl: – Isolated scapula fractures are rare → always search for associated chest injuries. – Winging of scapula = long thoracic nerve injury. – Glenoid/glenoid neck fractures often need surgical fixation.

📚 References

• TeachMeSurgery – Scapula Fractures
• Orthobullets – Scapula Fractures