Figure 1. Anteroposterior radiograph of the left shoulder.
Figure 2. Lateral radiograph of the left shoulder.
A 45-year-old woman presents to the emergency department with pain in her left shoulder after landing on it during a fall from her bicycle. She has been unable to lift her left arm since the fall. She underwent surgery on her clavicle 2 years ago following a similar injury. Anteroposterior and lateral radiographs of the left scapula (Figures 1 and 2) show a displaced and comminuted scapular body fracture.
Which of the following is the best treatment for this patient?
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Fractures of the scapula are often described as scapular neck or body fractures. Scapular neck fractures can be classified into intra-articular (involving the glenoid) and extra-articular. Displaced intra-articular scapular neck fractures and scapular neck fractures angulated >40° usually require surgery. Conversely, little evidence exists to suggest that displaced extra-articular scapular body fractures benefit from surgical fixation. The major muscles that attach to the scapula include the rhomboids posteriorly and the subscapularis anteriorly. The broad attachment sites of these muscles on the scapular body allow shoulder motion to be relatively preserved even if a displaced fracture of the scapula occurs. Displaced fractures of the scapular body usually heal well with little functional impairment. Treatment consists of 2 to 3 weeks in a sling followed by early mobilization. Pseudoparalysis of the shoulder often is present initially until the fracture begins to heal. Full active range of motion is allowed at 4 weeks; patients should expect a return to full activities 3 months after the injury.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
1. Schroder LK, Gauger EM, Gilbertson JA, Cole PA. Functional outcomes after operative management of extra-articular genoid neck and scapular body fractures. J Bone Joint Surg Am. 2016;98(19):1623-1630.
2. Cole PA, Gauger E, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg. 2012;20(3):130-141.