Fracture of the Scapula

A 56-year-old man, who was involved in an automobile accident, was brought to the emergency department by ambulance. He was awake, intoxicated with alcohol, and complained particularly of pain in his left shoulder. The patient was unable to recall any details of the accident; he believed that he had been hospitalized for a back spasm. Because of the patient’s discomfort, physical examination of his left shoulder was limited. Muscular or ligamentous injury was initially suspected, and a roentgenogram of the shoulder was obtained. The film revealed a comminuted fracture of the left scapula that involved the neck, body, and spine. The glenohumeral relationship was maintained. Also visualized was a fracture of the posterolateral aspect of the fourth through eighth ribs, an injury which can increase the risk of a tension pneumothorax, hemothorax, or pulmonary and visceral injury. Drs Luis Cabrera, Ali Ahmadizadeh, and John Carmody of Hoboken, NJ, write that a scapular fracture may occur from direct violence, sudden contraction of divergent muscles, or electric shock. Fractures to the body of the scapula, which usually result from high-energy trauma, are associated with the greatest morbidity. A plain x-ray film is diagnostic; a CT scan can detect involvement of the glenoid fossa. Because of the potential life-threatening complications that may occur in this setting, this patient was admitted to the ICU; he was immobilized, ice was applied locally, the rib fracture was managed conservatively, and analgesics were given. Healing may take between 4 and 6 weeks, depending on the patient’s general condition. Reduction of the scapula usually is not required, unless the fracture involves major displacement of the glenoid fossa.