Fractures of the Scapula: A Narrative Review on Diagnosis and Management

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 53-59 | Sujayendra Murali, Sandesh Madi, Raghuraj Kundangar, Monappa Naik, Anika Sait

Authors: Sujayendra Murali [1], Sandesh Madi [1], Raghuraj Kundangar [1], Monappa Naik [1], Anika Sait [1]

[1] Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal

Address of Correspondence
Dr.Sujayendra Murali
Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal -576104


Scapula fractures are relatively rare when compared to fractures of the other bones of the shoulder region. High-velocity injuries encountered in road traffic accidents are responsible for the increased incidence of these fractures. Intra-thoracic and cervical spine injuries can be associated with these fractures and warrants a thorough clinical examination. In an acute setting of patient resuscitation, the initial diagnosis of these fractures is frequently missed or delayed. Radiological assessment should include dedicated shoulder trauma X-ray series and computed tomography scans with three-dimensional reconstruction. Being suspended by the dense muscles of the shoulder complex, the union of these fractures is rarely a concern. However, with a better understanding of the biomechanics, the management of these fractures is gradually evolving. Only in recent times, the criteria for surgical intervention for these fractures have been defined. This narrative review aims to provide a brief overview of the recent advances and the changing concepts of these uncommon fractures.
Key words: Trauma; Scapula; Fracture classification; glenoid; algorithm.


1. Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med 2013;6:79-87.
2. Cole PA, Talbot M, Schroder LK, Anavian J. Extra-articular malunions of the scapula: A comparison of functional outcome before and after reconstruction. J Orthop Trauma 2011;25:649-56.
3. Hackney RG. Advances in the understanding of throwing injuries of the shoulder. Br J Sports Med 1996;30:282-8.
4. Myers JB, Riemann BL, Ju YY, Hwang JH, McMahon PJ, Lephart SM. Shoulder muscle reflex latencies under various levels of muscle contraction. Clin Orthop Relat Res 2003;407:92-101.
5. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma 1993;7:99-106.
6. DeFranco MJ, Patterson BM. The floating shoulder. J Am Acad Orthop Surg 2006;14:499-509.
7. Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: A marker for concomitant injury? A retrospective review of data in the national trauma database. J Trauma 2008;65:430-5.
8. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res 1998;347:122-30.
9. Anavian J, Conflitti JM, Khanna G, Guthrie ST, Cole, PA. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res 2011;469:3371-8.
10. Koh KH, Han, KY, Yoon YC, Lee SW, Yoo JC. True anteroposterior (Grashey) view as a screening radiograph for further imaging study in rotator cuff tear. J Shoulder Elbow Surg 2013;22:901-7.
11. Tuček M, Naňka O, Malík J, Bartoníček J. The scapular glenopolar angle: Standard values and side differences. Skeletal Radiol 2014;43:1583-7.
12. McAdams TR, Blevins FT, Martin TP, DeCoster TA. The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma 2002;16:7-11.
13. Bartoníček J, Frič V. Scapular body fractures: Results of operative treatment. Int Orthop 2011;35:747-53.
14. Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am 2009;91:2222-8.
15. Tadros AM, Lunsjo K, Czechowski J, Abu-Zidan FM. Multiple-region scapular fractures had more severe chest injury than single-region fractures: A prospective study of 107 blunt trauma patients. J Trauma 2007;63:889-93.
16. Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures. Rozhl Chir 2018;97:67-76.
17. Nau T, Petras N, Vécsei V. Fractures of the scapula-classification and treatment principles. Osteosynth Trauma Care 2004;12:174-9.
18. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26:41-5.
19. Woolnough T, Shah A, Sheean AJ, Lesniak BP, Wong I, Sa D. Postage stamp fractures: A systematic review of patient and suture anchor profiles causing anterior glenoid rim fractures after bankart repair. Arthroscopy 2019;35:2501-8.e2.
20. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res 1991;269:174-80.
21. Romero J, Schai P, Imhoff AB. Scapular neck fracture-the influence of permanent malalignment of the glenoid neck on clinical outcome. Arch Orthop Trauma Surg 2001;121:313-6.
22. Pace AM, Stuart R, Brownlow H. Outcome of glenoid neck fractures. J Shoulder Elbow Surg 2005;14:585-90.
23. Dimitroulias A, Molinero KG, Krenk DE, Muffly MT, Altman DT, Altman GT. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res 2011;469:1459-65.
24. Jones CB, Sietsema DL. Analysis of operative versus nonoperative treatment of displaced scapular fractures. Clin Orthop Relat Res 2011;469:3379-89.
25. McGinnis M, Denton JR. Fractures of the scapula: A retrospective study of 40 fractured scapulae. J Trauma 1989;29:1488-93.
26. Wilber MC, Evans EB. Fractures of the scapula. An analysis of forty cases and a review of the literature. J Bone Joint Surg Am 1977;59:358-62.
27. Gramstad GD, Marra G. Treatment of glenoid fractures. Tech Shoulder Elb Surg 2002;3:102-10.
28. Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Injury 2012;43:327-33.
29. Edwards SG, Whittle AP, Wood GW. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Joint Surg Am 2000;82:774-80.
30. Williams GR, Naranja J, Klimkiewicz J, Karduna A, Iannotti JP, Ramsey M. The floating shoulder: A biomechanical basis for classification and management. J Bone Joint Surg Am 2001;83:1182-7.
31. Gardner MJ, Kelly BT, Lorich DG. Treatment of glenoid fractures and injuries to the superior shoulder suspensory complex. In: Dines DS, Lorich DG, Helfet DL, editors. Solutions for Complex Upper Extremity Trauma. New York: Thieme; 2008.
32. Ogawa K, Naniwa T. Fractures of the acromion and the lateral scapular spine. J Shoulder Elbow Surg 1997;6:544-8.
33. Ogawa K, Yoshida A, Takahashi M, Ui M. Fractures of the coracoid process. J Bone Joint Surg Br 1997;79:17-9.
34. Ogawa K, Matsumura N, Ikegami H. Coracoid fractures: Therapeutic strategy and surgical outcomes. J Trauma Acute Care Surg 2012;72:E20-6.
35. Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg Br 1995;77:425-8.
36. Goss TP. The scapula: Coracoid, acromial, and avulsion fractures. Am J Orthop (Belle Mead NJ) 1996;25:106-15.
37. Anavian J, Wijdicks CA, Schroder LK, Vang S, Cole PA. Surgery for scapula process fractures: Good outcome in 26 patients. Acta Orthop 2009;80:344-50.
38. Judet R. Traitement chirurgical des fractures de l’omoplate. Acta Orthop Belg 1964;30:673-8.
39. Van Oostveen DP, Temmerman OP, Burger BJ, Van Noort A, Robinson M. Glenoid fractures: A review of pathology, classification, treatment and results. Acta Orthop Belg 2014;80:88-98.
40. Avramidis G, Brilakis E, Deligeorgis A, Antonogiannakis E. All-arthroscopic treatment of glenoid rim fractures. Arthrosc Tech 2019;8:e1121-4.
41. Corradini A, Campochiaro G, Gialdini M, Rebuzzi M, Baudi P. Arthroscopic repair of glenoid rim fractures: A ligamentotaxis surgical technique. Musculoskelet Surg 2018;102 Suppl 1:41-8.
42. Maziak N, Minkus M, Krüger D, Scheibel M. Arthroscopic reconstruction of multifragmented anteroinferior glenoid rim fractures. JBJS Essent Surg Tech 2019;9:e36.1-6.
43. Bonnevialle N, Clavert P, Arboucalot M, Bahlau D, Bauer T, Ehlinger M, et al. Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: A comparison with open surgery. J Shoulder Elbow Surg 2019;28:42-7.
44. Cole PA, Dugarte AJ. Posterior scapula approaches: Extensile and modified judet. J Orthop Trauma 2018;32 Suppl 1:S10-1.
45. Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg 2012;20:130-41.

How to Cite this article: Murali S, Madi S, Kundangar R, Naik M, Sait A | Fractures of the Scapula: A Narrative Review on Diagnosis and Management | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 53-59.

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