In layman’s terms, the scapula is known as the wing bone. There are 2 in the normal human anatomy, and you can feel them on both sides of the upper back. There is a lot of soft tissue and muscle surrounding these bones, therefore, fractures of the scapula are fairly uncommon. Of all the broken bones around the shoulder, scapula fractures only account for about 5%. Typically, the fracture of the scapula is a result of a high-energy trauma such as a car accident. When a scapular fracture is seen, particular suspicion should be given to looking for additional injuries such as a lung injury, rib fractures, or other damage to the arm on the same side. These additional injuries are seen about 90% of the time. It would be unusual for a patient with a scapula fracture not to end up in the emergency room. This is not your typical “I fell on my arm and broke my wrist” scenario where the patient may try and sleep it off and then show up the next day in a doctor’s office. A fall from a building, or a car or motorcycle accident, etc is what is happening here. As mentioned, there are typically significant associated injuries, so a full neurologic and vascular examination is necessary. It may be difficult to do a full examination as typically it is a very painful injury and there is often a rib fracture which may prevent the arm or body from being moved as necessary to do the exam. Plain x-rays after this type of trauma can be very helpful and are necessary to obtain. However, the most important radiographic study is a CAT scan. This can show how much the bone is separated and what kind of an angle there is to the break. Scapular fractures are categorized according to where in the bone the break occurs. It is often determining where the break occurs that then determines if the fracture can be treated without surgery or will need an operation. Typically, a nonoperative approach to scapula fractures is the best method of treatment. If a fracture occurs in the body of the bone, nonsurgical results have been satisfactory. Studies have shown that with long-term follow-up, one fourth of the patients did have some slight disability with either mild pain or range of motion being affected. The area of the scapula that joins up with the shoulder needs to be evaluated carefully as to whether surgery should be performed. This is called the scapular neck. Fractures of this area are very close to the region where the shoulder joint connects with the scapula and there should be a much lower threshold for surgery than otherwise. Indications for surgery in this area of the scapula are poorly defined. Some go by the definition of if the fracture is displaced by over a centimeter or if there is over 40° of an angle to the fracture pieces then surgery should be performed. But this is not a black-and-white area. If you have been involved in a high-energy trauma is best to have a board-certified orthopedic surgeon working on your case. Dr. Sumit Dewanjee of FXRX Inc if the premier practice of orthopedic doctors in Phoenix AZ and also has Orthopedic Surgeons Scottsdale AZ. He specializes in the treatment of knee, shoulder and hip problems such as scapula fractures and other extremity problems. Call today at 480 449-3979 to make your appointment today.
