From the Guidelines
Treatment for scapular fractures should be individualized based on the severity and location of the injury, with a focus on maintaining shoulder function while allowing bone healing. For isolated scapula body fractures, conservative management is often sufficient, as these fractures tend to heal well without surgical fixation 1. However, associated rib fractures or higher injury severity scores may benefit from more aggressive surgical fixation, as they are associated with worse clinical outcomes 1.
Conservative Management
- For minimally displaced fractures, pain control with NSAIDs and a brief period of immobilization using a sling for 2-3 weeks is typically recommended
- Physical therapy should begin as soon as pain allows, usually within 1-2 weeks, focusing on pendulum exercises initially and progressing to active range of motion
- For moderately displaced fractures, similar conservative treatment is often sufficient, but immobilization may extend to 3-4 weeks before beginning rehabilitation
Surgical Intervention
- Severely displaced fractures, especially those involving the glenoid, scapular neck, or acromion with significant displacement or angulation, typically require surgical intervention with open reduction and internal fixation using plates and screws
- Surgery is also indicated when fractures involve the articular surface with significant step-off, when there's significant instability, or when associated with other injuries like clavicle fractures in the "floating shoulder" pattern 1
- Post-surgical rehabilitation follows a similar protocol to conservative management but with more careful progression, prioritizing the maintenance of shoulder function while allowing bone healing.
From the Research
Treatment Options for Scapular Fractures
The treatment of scapular fractures depends on the degree and type of fracture, as well as the presence of any associated injuries. The following are some of the treatment options available:
- Nonoperative treatment: This is often used for nondisplaced or minimally displaced fractures, and may involve immobilization in a sling, followed by physical therapy to regain range of motion and strength 2.
- Open reduction and internal fixation (ORIF): This is a surgical procedure that involves reducing the fracture and stabilizing it with internal fixation devices such as plates, screws, or K-wires. ORIF is often used for displaced or comminuted fractures, as well as for fractures that involve the glenoid or other articular surfaces 3, 4, 5.
- Posterior approach: This is a surgical approach that involves making an incision in the posterior aspect of the scapula to access the fracture site. The posterior approach can be used for fractures that involve the posterior aspect of the scapula, such as the scapular spine or the infraspinatus fossa 5.
Indications for Operative Treatment
The indications for operative treatment of scapular fractures include:
- Displaced intra-articular glenoid fractures
- Double disruptions of the shoulder suspensory complex
- Floating shoulder injuries
- Significant angulation and displacement of the scapular neck
- Fractures that involve the coracoid process or the acromion 4, 5
Outcomes of Treatment
The outcomes of treatment for scapular fractures can vary depending on the type and severity of the fracture, as well as the treatment method used. Studies have shown that ORIF can result in good-to-excellent clinical outcomes, with minimal risk of complications 3, 5. Nonoperative treatment can also result in good outcomes, especially for nondisplaced or minimally displaced fractures 2.
Complications of Treatment
The complications of treatment for scapular fractures can include: