Scapular Fracture Treatment
Primary Treatment Recommendation
Most isolated scapular body fractures should be managed non-operatively with sling immobilization and early mobilization, as they heal well without surgery and achieve satisfactory functional outcomes. 1
Initial Assessment and Imaging
- Obtain CT imaging immediately after plain radiographs to fully characterize the fracture pattern, as scapular fractures are easily missed or underappreciated on conventional radiography due to the scapula's complex anatomy and overlying ribs 1
- CT is essential for assessing intra-articular extension, glenopolar angulation, AP angulation, and lateral border offset 1
- Three-dimensional reformatted CT images provide superior visualization of displacement and angulation 1
Non-Operative Management Protocol
For isolated scapular body fractures (the majority of cases):
- Initiate sling immobilization for comfort only, typically 1-2 weeks 1
- Begin range-of-motion exercises for shoulder, elbow, wrist, and hand within the first few days as pain allows 1
- Patients may discard the sling as early as pain permits 1
- Restrict above-chest-level activities until fracture healing is evident (typically 6-8 weeks) 1
- Avoid overly aggressive physical therapy early on, as this may compromise healing 1
Surgical Indications
Consider operative fixation for:
- Displaced intra-articular glenoid fractures with significant articular involvement 2, 3
- Scapular neck fractures displaced >10mm, which show better functional outcomes with surgery 4
- Glenoid rim fractures associated with humeral head subluxation, as these compromise glenohumeral stability 2, 3
- Unstable scapular neck fractures that may affect shoulder mechanics 2, 3
Critical Pitfalls to Avoid
- Do not miss associated injuries: Scapular fractures result from high-energy trauma and commonly occur with rib fractures, pneumothorax, neurovascular injuries, and cerebral contusions 5
- Associated rib fractures or higher injury severity scores predict worse clinical outcomes and may warrant more aggressive management 1
- Isolated scapular body fractures have excellent prognosis, but multitrauma patients show significantly worse functional outcomes even with appropriate fracture management 6
Expected Outcomes
- Isolated scapular body fractures treated non-operatively achieve functional shoulder scores equal to the general population and range of motion equal to the uninjured contralateral shoulder 6
- Operative treatment of appropriately selected displaced fractures yields 64-79% complete functional recovery 2
- The remaining patients may experience varying degrees of pain, loss of mobility, and weakness, but overall good-to-excellent results occur in approximately 79% of surgical cases 2
Special Considerations for Elderly Patients
- All patients ≥50 years with scapular fractures require systematic osteoporosis evaluation, ideally through a Fracture Liaison Service 7
- Ensure vitamin D supplementation (600-800 IU daily) and calcium intake (1,000-1,200 mg daily) 7
- Implement multidimensional fall prevention strategies given the high-risk nature of this population 1, 7