Scapula (Shoulder Blade) Fractures
High-energy injuries with unique management considerations
Understanding Scapula Fractures
Scapula fractures are uncommon (3-5% of shoulder fractures, 1% of all fractures) because the scapula is protected by thick surrounding muscles. They typically result from high-energy trauma (motor vehicle accidents, falls from height).
Key Point: Due to the high-energy mechanism, 90% of patients have associated injuries (rib fractures, pulmonary contusion, clavicle fractures, brachial plexus injury). A thorough trauma evaluation is essential.
Classification
• 50-60% of scapula fractures
• Usually from direct blow
• Almost always non-operative
• Excellent outcomes
• 10% of scapula fractures
• Intra-articular (joint surface)
• May require surgery if displaced
• Risk of arthritis if malunited
• 25% of scapula fractures
• Connects body to glenoid
• Surgery if severely angulated
• Watch for floating shoulder
• Less common
• Acromion: may narrow subacromial space
• Coracoid: check for associated injuries
• Surgery if significantly displaced
Treatment
• Sling for comfort (2-4 weeks)
• Early gentle range of motion
• Progressive rehabilitation
• Return to activity as tolerated
Outcomes are excellent due to rich muscle coverage providing blood supply and inherent stability.
• Glenoid fractures with >4mm step-off or >20% articular involvement
• Scapular neck with >40° angulation or >25mm medialization
• Floating shoulder (combined clavicle + scapula neck fracture)
• Acromion fractures narrowing subacromial space
Scientific References
1. Cole PA, et al. Scapula fractures. Orthop Clin North Am. 2013
2. Zlowodzki M, et al. Operative treatment of acute displaced scapula fractures. J Orthop Trauma. 2006
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)
