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trauma

Scapula Fracture

advanced
6 min
24 marks
6 questions
Clinical Scenario
A 55-year-old motorcyclist presents after a high-speed collision with multiple injuries. Chest injuries have been managed by the trauma team (rib fractures and haemothorax). He has significant right shoulder pain and difficulty moving his arm. On examination, there is bruising over the scapula and shoulder with painful limited range of motion. Peripheral neurovascular status is intact.
AP and Y-view scapular radiographs showing displaced scapular body and neck fracture with medialization of the glenoid. Associated clavicle fracture visible creating a floating shoulder pattern.
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AP and Y-view scapular radiographs showing displaced scapular body and neck fracture with medialization of the glenoid. Associated clavicle fracture visible creating a floating shoulder pattern.

Source: Educational radiograph of a floating shoulder injury • OrthoVellum Medical Education Team • OrthoVellum Educational Use

Questions

Question 1 (4 marks)

What associated injuries should you assess for with this mechanism and fracture pattern?

Question 2 (4 marks)

Describe the Superior Shoulder Suspensory Complex (SSSC) and define a "floating shoulder."

Question 3 (5 marks)

What are the indications for operative management of scapular fractures?

Question 4 (5 marks)

Describe the surgical approach and fixation technique for scapular body/neck fractures.

Question 5 (3 marks)

How does a floating shoulder affect your management approach?

Question 6 (3 marks)

What outcomes would you counsel this patient about?

Exam Day Cheat Sheet

Must Mention

  • •80-90% have associated injuries (chest most common)
  • •SSSC = Superior Shoulder Suspensory Complex (bone-ligament ring)
  • •Floating shoulder = clavicle + scapula neck (double SSSC disruption)
  • •GPA <22° or medialization >15-20mm = surgical indication
  • •Judet posterior approach for scapula body/neck
  • •Fix clavicle first, then reassess scapula

Common Pitfalls

  • •Missing pulmonary/chest injuries (80%+ association)
  • •Not checking brachial plexus
  • •Not recognizing SSSC and floating shoulder concept
  • •Operating on isolated minimally displaced scapula
  • •Not fixing clavicle first in floating shoulder
  • •Suprascapular nerve injury during posterior approach