A fractured scapula involves a break in the triangular bone located on the upper back that connects the upper arm to the torso. Protected by muscle and the rib cage, it is an uncommon injury, accounting for less than one percent of all broken bones. Fractures result from high-impact force and are often associated with other serious injuries, frequently involving the chest, head, or spine.
Mechanism of Injury and Common Symptoms
The high degree of force needed to fracture the scapula means the mechanism of injury is severe blunt trauma. Major causes include high-speed motor vehicle collisions and falls from significant heights. Direct blows to the back or side of the shoulder, such as during contact sports, can also generate enough energy to cause a fracture. Because of the extreme force involved, a scapula fracture is associated with other injuries in 80 to 95 percent of cases, including fractured ribs, punctured lungs, and collarbone breaks.
Symptoms immediately following the trauma are intense, beginning with severe, localized pain over the shoulder blade. This pain is worsened by any attempt to move the arm. Swelling and bruising rapidly develop around the shoulder blade. The pain can be so severe that the patient has extreme difficulty moving the arm, sometimes described as pseudo-paralysis.
Anatomical Classification of Fractures
Scapula fractures are classified based on the location of the break, which helps determine the appropriate treatment approach. The most common are fractures of the scapular body, the large, flat, triangular portion of the bone, occurring in 50 to 60 percent of cases.
Fractures of the scapular neck involve the constricted area connecting the main body to the shoulder joint socket, representing about 25 percent of all scapula fractures. Breaks affecting the glenoid—the shallow socket that forms the shoulder joint—are referred to as intra-articular fractures. Glenoid fractures can be further categorized using systems like the Ideberg classification, which details the pattern of the break within the joint surface.
Diagnosis and Non-Surgical Management
Diagnosis begins with a physical examination to assess the shoulder’s position and check for associated injuries. Initial imaging involves standard X-rays, often taken from multiple angles. Because of the complex, overlapping structures of the chest and shoulder, a Computed Tomography (CT) scan is frequently used to accurately characterize the fracture pattern and assess displacement.
The stability of the fracture is the primary factor dictating treatment. Most scapular body and minimally displaced fractures are managed non-surgically. The standard protocol involves short-term immobilization using a sling or swathe for comfort and support. Pain is managed with medications, and patients are encouraged to begin early functional rehabilitation with finger and hand motion to prevent stiffness. Early range-of-motion exercises for the shoulder are also introduced as soon as pain allows to avoid the development of a frozen shoulder.
Surgical Intervention and Recovery Outlook
Surgical intervention is reserved for a minority of scapula fractures, estimated to be 10 percent of cases. Surgery becomes necessary when the fracture is severely displaced or compromises the function of the shoulder joint. This includes displaced intra-articular fractures that affect the smooth congruity of the glenoid joint surface. Unstable fractures of the scapular neck or those involving significant angulation are also candidates for surgical fixation.
The goal of surgery, Open Reduction and Internal Fixation (ORIF), is to precisely realign and stabilize the bone fragments using plates and screws. This procedure restores the anatomical alignment of the joint, which is important for fractures involving the glenoid. Following surgery, the patient is immobilized in a sling for six weeks to allow healing. A structured physical therapy program is then initiated to restore strength and full range of motion. Full recovery often takes several months, with patients regaining muscle strength and mobility within three to six months.