Superior Shoulder Suspensory Complex
Muscles of the Scapula
Blood Vessels and Nerves of the Scapula
Mechanisms of Injury
Signs and Symptoms
Imaging and Other Diagnostic Methods
Treatment of Individual Fracture Types
Author’s Preferred Method of Treatment for Scapula Body Fractures
Author’s Preferred Method of Treatment for Scapula Neck Fractures
Author’s Preferred Method of Treatment for Glenoid Fractures
Complications of Nonoperative Treatment
Complications of Operative Treatment
Summary, Controversies, and Future Directions
Significantly displaced fractures of the scapular body are indications for operative treatment via the Judet approach (Fig. 39-16). The first and most important goal is restoration of the integrity of the lateral border of the body and, consequently, the relationship between the border and glenoid. Where necessary, internal fixation is performed in the spinomedial and inferior angles of the scapula. In the presence of an associated fracture of the clavicle, internal fixation of the scapula should be performed first and then followed by internal fixation of the clavicle.14,15
In younger, physically active patients all three types of scapular neck fractures, if displaced, are indications for operative treatment via the Judet approach using plates and lag screws (Fig. 39-17).
Displaced fractures of the glenoid, mainly those of its anterior rim and of its lower part, are indications for surgery, mainly in younger or physically active patients. Surgical fixation of a larger avulsion of the anterior rim restores congruity and stability to the glenohumeral joint.
Fractures of the inferior glenoid and fractures of the scapular body may be treated from the posterior Judet approach which allows a simultaneous reconstruction of both the articular surface and the biomechanical body of the scapula. The posterolateral approach provides only a limited exposure of the inferior glenoid and lateral border of the scapula and is not suitable for treatment of these cases. Internal fixation is performed using a combination of lag screws and plates, depending on the fracture anatomy (Fig. 39-19). Stable internal fixation allows rehabilitation to start immediately after operation.
Adapted from Zelle BA, Pape HC, Gerich TG, et al. Functional outcome following scapulothoracic dissociation. J Bone Joint Surg Am. 2004;86-A:2–7.