The scapula is a flat triangular bone situated on the posterolateral aspect of the chest wall. Its primary function is to attach the upper extremity to the thorax and provide a stabilized fulcrum for upper limb movement. The scapula is suspended from the clavicle by the acromioclavicular and coracoclavicular ligaments and articulates with the humerus.
The scapula is well protected by its surrounding musculature (supraspinatus, infraspinatus, subscapularis) which allows the scapula to recoil on impact. This explains the infrequent occurrence of scapular fractures. When they do occur, they are the result of significant blunt trauma. Common mechanisms include fall from a height and high speed motor vehicle accidents.
Fracture of the scapula are commonly associated with other injuries. The most common are rib fractures (as high as 50%), lung injuries, clavicle fracture and injuries to the brachial plexus and adjacent vessels.
Most scapula fractures can be treated non-operatively. However, certain fracture configurations require surgical fixation for the best possible outcome. These include:
- Floating shoulder with fracture of the clavicle and scapular neck
- Displaced fracture of the coracoid and acromion
- Displaced glenoid rim fractures especially when associated with glenohumeral instability
- Significantly displaced scapular spine fractures