INTRODUCTION: Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention. PATIENT AND CLINICAL HISTORY: A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall. SURGICAL TECHNIQUE: Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization. RESULTS: The patient's symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur. DISCUSSION: This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.
INTRODUCTION: Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention. PATIENT AND CLINICAL HISTORY: A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall. SURGICAL TECHNIQUE: Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization. RESULTS: The patient's symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur. DISCUSSION: This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.
Authors: Bryan M Armitage; Coen A Wijdicks; Ivan S Tarkin; Lisa K Schroder; Daniel J Marek; Michael Zlowodzki; Peter A Cole Journal: J Bone Joint Surg Am Date: 2009-09 Impact factor: 5.284