Scapular Fracture
What is it: A fracture to any portion of the scapula bone; the body, coracoid process, acromion, glenoid fossa and neck, or spine.
How does it present: Fractures of the scapula most commonly result from a direct blow to the area or fall onto the area. Fractures of the glenoid can occur after a fall on to an outstretched hand.
Common exam findings: Patients with a fracture will often experience tenderness in that region and avoid movement of the arm, especially in abduction. The fractures usually result from significant force, so be sure to evaluate for other associated lung, rib, clavicle and brachial plexus injuries.
Tests and treatment: X-rays are needed to evaluate for the scapular fracture. If suspected, but not seen on x-ray, a CT scan may be helpful. In the case of glenoid fractures, a CT scan can better identify the location and displacement of the fracture as well as the location of the humeral head - all of which are important for determining appropriate care. Treat fractures of the body of the scapula with splinting in an arm sling coupled with a gradual increase in range of motion exercises. Fractures involving the glenoid should be considered for referral to orthopedics when the fractures are displaced, involve greater than 25% of the articular space, or if the humeral head is not seated correctly. Displaced coracoid and acromion fractures should also be referred.