Scapular fracture: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray205 left scapula lateral view.png|thumb|Scapula anatomy.]] | |||
[[File:Gray203.png|thumb|Scapula anatomy.]] | |||
*Occurs via direct trauma to shoulder area or FOOSH | *Occurs via direct trauma to shoulder area or FOOSH | ||
**Fractures of body and glenoid are most common | **Fractures of body and glenoid are most common | ||
*>75% are | *>75% are associated with other injuries (ribs, lung, shoulder girdle) | ||
*Association with [[thoracic aortic injury]] classically taught, but actually <1% association in clinical practice | |||
==Clinical Features== | ==Clinical Features== | ||
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{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
==Diagnosis== | ==Evaluation== | ||
* | [[File:FracturedGlenoid.png|thumb|X-ray showing a fracture of the scapula and clavicle.]] | ||
[[File:PMC3259405 13244 2011 72 Fig28 HTML.png|thumb|Sagittal reconstructed CT image showing multiple fractures of the left scapula.]] | |||
[[File:ScapulaFracture.png|thumb|A right sided scapula fracture with rib fractures underneath seen on a 3D reconstruction of a CT scan.]] | |||
===Workup=== | |||
*CT chest with contrast (trauma protocol) | |||
===Diagnosis=== | |||
*While a dedicated scapular series (AP, lateral, axillary) will identify most fractures, CT chest is typically indicated to exclude other injuries. | |||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Rule-out other injuries | *Rule-out other injuries | ||
**Low threshold for additional CT imaging or obs | **Low threshold for additional CT imaging or obs | ||
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==Disposition== | ==Disposition== | ||
*Typically discussed with orthopedic specialist with in ED | |||
*If no other injuries of significance, may be discharged home | |||
===Sub-Specialty Care=== | |||
Indications for surgery: | |||
*Glenohumeral instability | |||
*Displaced scapular neck fracture | |||
*[[Open fracture]] | |||
*Loss of rotator cuff function | |||
*Displaced coracoid fracture | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 13:21, 10 April 2021
Background
- Occurs via direct trauma to shoulder area or FOOSH
- Fractures of body and glenoid are most common
- >75% are associated with other injuries (ribs, lung, shoulder girdle)
- Association with thoracic aortic injury classically taught, but actually <1% association in clinical practice
Clinical Features
- Localized tenderness over scapula with ipsilateral arm held in adduction
- Any arm movement will worsen pain
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Workup
- CT chest with contrast (trauma protocol)
Diagnosis
- While a dedicated scapular series (AP, lateral, axillary) will identify most fractures, CT chest is typically indicated to exclude other injuries.
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Rule-out other injuries
- Low threshold for additional CT imaging or obs
- Sling, ice
Disposition
- Typically discussed with orthopedic specialist with in ED
- If no other injuries of significance, may be discharged home
Sub-Specialty Care
Indications for surgery:
- Glenohumeral instability
- Displaced scapular neck fracture
- Open fracture
- Loss of rotator cuff function
- Displaced coracoid fracture