What are the potential complications of a left scapular fracture?

Complications of Left Scapula Fracture

Scapular fractures are sentinel injuries that signal high-energy trauma with a characteristic pattern of associated injuries affecting the ipsilateral chest, lung, and shoulder girdle structures—these associated injuries, not the fracture itself, drive morbidity and mortality.

Associated Injuries (The Primary Concern)

The most critical aspect of scapular fractures is recognizing they serve as a clinical marker for severe concomitant injuries. In 83% of cases, significant associated injuries are present 1, 2. The injury pattern is predictable and requires systematic evaluation:

Thoracic Injuries (Most Common and Life-Threatening)

• Rib fractures occur in 53-65% of cases 1, 2
• Pulmonary contusions in 54% of patients 1
• Pneumothorax or hemothorax in 39% when combined with rib fractures 2
• Critical pitfall: Half of all deaths from scapular fractures result from pulmonary sepsis arising from ipsilateral lung contusions 1. The mortality rate is 14.3% overall, driven entirely by associated injuries, not the scapular fracture itself 1.

Shoulder Girdle Injuries

• Clavicular fractures in 27% of cases 1, 2
• Brachial plexus injury in 12.5% 1
• Subclavian, axillary, or brachial artery injury in 10.7% 1

Other Associated Injuries

• Head injuries in 26% 2
• Long bone fractures (lower extremity in 7 cases, upper extremity in 3 cases per study cohort) 2
• Acetabular fractures, vertebral fractures, and kidney contusions occur in isolated cases 2

Surgical Complications (When ORIF is Performed)

For patients undergoing open reduction and internal fixation, the 30-day complication profile is relatively low but varies by fracture location:

Short-term Complications (30-90 days)

• Overall adverse event rate: 2.0% 3
• Reoperation: 3.98-6.2% (most common complication) 3, 4
• Surgical site infection: 0.8% 3
• Wound dehiscence, stroke, transfusion, pneumonia: each <1% 3

For coracoid fractures specifically:

• Shoulder dislocation risk: 3.6% at 3 months 4
• Brachial plexus injuries: 3.0% at 3 months 4

For acromion fractures specifically:

• Malunion/nonunion: 4.6% at 5 years 4
• ORIF revision: 6.2% at 5 years 4
• Shoulder osteoarthritis: 10.3% at 5 years 4

Risk Factors for Complications

• Steroid use increases risk of any adverse event 55-fold (OR: 55.57) 3
• Outpatient status is protective against reoperation (OR: 0.11) 3

Long-term Complications (Conservative or Surgical Management)

For Glenoid Fractures (Nonsurgical Management)

• Shoulder stiffness, osteoarthritis, and eventual need for arthroplasty at all time intervals 4
• These patients require close long-term monitoring

Functional Impairment

• Glenohumeral joint dysfunction may occur when fractures are displaced or involve articular surfaces 5
• Surgery is indicated when joint function is impaired, considering patient age, occupation, and clinical status 5

Clinical Algorithm for Management

1. Initial assessment: Assume high-energy trauma—systematically evaluate for life-threatening associated injuries
2. Immediate priorities:
   • Ipsilateral chest/lung injuries (pneumothorax, hemothorax, pulmonary contusion)
   • Vascular injuries (subclavian/axillary/brachial arteries)
   • Neurological injuries (brachial plexus)
3. Imaging: CT is superior to radiographs for characterizing fracture patterns, intraarticular extension, angulation, and lateral border offset 6
4. Surgical decision-making: Reserve ORIF for fractures impairing glenohumeral function, considering the low but real complication rates
5. Monitoring: Patients with pulmonary contusions require vigilant respiratory monitoring to prevent sepsis—the leading cause of death 1

The scapular fracture itself rarely causes death or significant morbidity; missing the associated injuries does 1, 5.