Management of Scapular Fractures

With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as allowed by the patient’s pain. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. However, little agreement exists on indications for surgery, and there is no clear comparative evidence on outcomes for surgically versus nonsurgically managed fractures. Scapular fractures are the result of high-energy mechanisms of injury, and they often occur in conjunction with other traumatic injuries. In addition to performing meticulous physical and neurologic examination, the surgeon should obtain plain radiographs, including AP shoulder, axillary, and scapular Y views. Three-dimensional CT is used to determine accurate measurements in surgical candidates. Surgical approach, technique, and timing are individualized based on fracture type and other patient-related factors. With regard to documenting and surgically managing scapula fractures, the French have historically dominated the field, with important contributions by Paré, Petit, Desault, Du Verney, Lenormant, Dujarier, Malgaigne, Basset, Dupont, Judet, and Evrard, among others. The first depiction of a scapula fracture was published in 1579 by Ambroise Paré in a description of a battle injury: “When the fracture involves the neck of the scapula, the prognosis is almost always fatal.” Perhaps the fatality resulted from what we now know to be commonly associated injuries such as pneumothorax or head and neck injury. The first classification of scapula fractures was developed by JeanLouis Petit, who divided scapula fractures into body, neck, and process. He further subdivided fracture of the scapular body into longitudinal, transverse, and oblique. In 1913, Albin Lambotte of Belgium was the first to describe internal fixation of the scapula. He included preoperative and postoperative radiographs as documentation. However, it was Grune and Plagemann who, in 1911, presented the first radiographic series detailing fracture characteristics in 13 and 19 cases, respectively. Several documented cases of surgical management of scapula fractures existed by the early 1900s. In 1916, Hitzrot and Bolling published a history of treatment in the latter half of the 1800s and reported on eight cases of their own, which was the largest surgical series to date. The first documented scapula fracture operation in the United States was performed by Longabaugh in 1924. In 1938 and 1939, respectively, Reggio and Fischer were the first and second perPeter A. Cole, MD