Scapula fractures: a review

A consensus is beginning to emerge about the indications for fixation of fractures involving the glenoid fossa of the scapula. The same cannot be firmly said for extra-articular fractures of the blade or the processes of the scapula, with a good deal of reliance on expert opinion from high-volume centres. There are no randomized controlled studies and the systematic reviews that do exist can only pool the data from available case series, making meaningful meta-analysis of limited value. Interest in scapula fractures has increased of late due to the specific association of fractures of the scapular spine and acromion with reverse shoulder arthroplasty. This review summarizes the available evidence that can assist decision making when faced with a patient with a scapula fracture. Which patients should at least be considered for open reduction and internal fixation, either in the centre where they present or after referral to a more specialist centre? These patients are those with a fracture sufficiently displaced that it interferes with the mechanical function of the shoulder girdle and the aim of fixation is to reduce pain and disability. Since the majority of scapula fractures heal quickly with non-surgical treatment and do not cause significant disability, decision making can be difficult, and it is perhaps the case that it is easier to err on the side of caution. However, it seems that there are fracture types, such as significantly displaced double disruptions of the superior suspensory complex, widely displaced lateral column fractures and fractures producing angular deformity of the glenoid process, that benefit from early reduction and stabilization with the expectation of a good outcome for the patient. Cite this article: EFORT Open Rev 2021;6:518-525. DOI: 10.1302/2058-5241.6.210010

Evaluating the Fit of Current Anatomical Scapula Reconstruction Plates: A Study Using Fifty Scapulae

Open Reduction and Internal Fixation (ORIF) of scapula fractures have increased in numbers recently. This is due to better functional outcomes achieved post-ORIF than non-operative management techniques. In South Africa, there is only one available supplier for anatomical contoured scapula plates used in the ORIF. This study examines the fit of these plates on the bony topology of fifty healthy scapula. It was observed that the short medial body plate performed the best in adhering to the bone topology followed by the short acromion plate. The glenoid plate and the long acromion and body plates were not adequately designed to fit their intended regions on the scapula. In conclusion, this study highlights the drawbacks in design of current commercial plates available for ORIF of scapula. Further studies are needed in order to evaluate the quantitative-fit performance of these plates on fracture scapula surfaces.

Scapula Fractures in Elite Soccer and Rugby Players

Background: Scapula fractures are uncommon in sports and are poorly understood in this patient group. Purpose: To report on scapula fractures in contact and collision athletes and assess the injury patterns of different mechanisms of injury. Study Design: Case series; Level of evidence, 4. Methods: A retrospective case series was performed of all sports-related scapula fractures treated at a single institution between 2007 and 2015. The mechanisms of injury were divided into direct lateral impact, fall onto an outstretched arm, or abduction/external rotation. Results: A total of 11 patients were identified: 9 professional rugby players, 1 professional soccer player, and 1 amateur soccer player. The mean age was 28 years (range, 18-35 years). The mean return to play was 127 days in those treated nonoperatively and 163 days in those treated operatively. A direct impact mechanism occurred in 7 patients, all of whom sustained glenoid neck and body fractures and were treated nonoperatively. Two rugby players had a concomitant suprascapular nerve injury. An outstretched arm mechanism occurred in 2 cases, leading to posterior and inferior glenoid fractures. Both patients were treated operatively. An abduction/external rotation mechanism occurred in 2 cases, resulting in an anteroinferior and an anterior glenoid rim fracture. One case was treated operatively and the other was treated nonoperatively. Of those with glenoid fractures, 75% were not visible on plain radiographs and required further imaging. Conclusion: Scapula fractures acquired in sports are a serious injury with a prolonged recovery period. The mechanism of injury can help predict the injury pattern and highlight the need for further imaging. There is a high association with suprascapular nerve injuries.