Association of scapular fractures and blunt thoracic aortic injury: fact or fiction?

It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.