Unusual Presentation of Fracture Scapula

Majority of the scapular fractures does not require adequate surgical intervention. The scapular fractures with minimal displacement heal without any functional deficits. But, the literature suggest that, non-operative management with minimal displacement can lead to the persistent symptoms and decreased function of the shoulder girdle. A prospective study was undertaken in the department of Orthopedics of Medical College and General Hospital among the 30 cases of glenoid neck and scapular body fractures between December 2016 to June 2018. The cases were also followed up for period of 6 months with clinical and radiological evaluations. Road traffic accident was the main reason for majority of scapular fractures in this study. About 70% of the males and 70% of the females had scapular injuries due to road traffic accidents. In males, road traffic accident was followed by, fall from height (15%), direct blow (10%) and fall of heavy object in 5% of the study group. In females road traffic accidents were followed by fall from height in 30% of the cases. This difference in mode of injury was not statistically significant between the males and females.

Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention. A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall. Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization. The patient's symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur. This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.

Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective. The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre. The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries. One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma. A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world. Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.

Objective To study the relationship between the fractured scapular location, the number of fractured scapular regions and the distribution and severity of associated injuries in patients with multiple trauma. Methods One hundred and fifteen consecutive patients with fractured scapula were retrospectively studied between August 2006 and March 2008. There were 96 males and 19 female with an average age of 37.9 years. Mechanism of injury, associated injuries, abbreviated injury soore (AIS) for each part, injury severity score (ISS), and the location and the number of anatomic scapular regions involved in each fracture were studied. Patients were divided into single-region fracture (SRF) group and multiple-region fracture (MRF) group. Furthermore, the SRF group was subdivided into three groups according to their anatomic location: 1) the muscle covered part, 2) the apophyseal part and 3) the glenoid part. Computer tomography and plain radiographs was used for fracture classification in all patients. Results Most scapular fractures were a part of severe multiple trauma, with mean ISS 14.0 among them 42 cases (36.5%) were greater than 16. Road traffic accident was the most common cause for scapular fracture. Ninety-eight patients (85.2%) sustained associated injury. The most frequent part involved was chest(85/115, 73.9%). ISS and AIS for the chest injuries were higher in patients with multiple scapular fractures or scapular fractures in muscle covered part. Conclusion Scapular fractures are usually caused by directly high energy trauma, accompanied by associated injuries. The most frequent region was chest injury. MRF may serve as an external skeletal marker of severe chest injury. Key words: Shoulder fractures; Scapula; Wounds and injuries; Thorax

IntroductionScapular anatomical neck fractures are among the most infrequent shoulder girdle fractures. Only seven radiologically confirmed cases of scapular anatomical neck fractures have been documented in the literature to date, of which only one case underwent delayed surgery.Case presentationA 34-year-old male Persian patient with morbid obesity was diagnosed with a scapula anatomical neck fracture after a motor vehicle collision. The radiographic assessment of the patient indicated an increase in the scapular glenopolar angle (73.9°). Due to concurrent chest and head injuries, surgical intervention was deferred until 6 weeks following the injury. The posterolateral limited Dupont–Evrard approach was used because of the patient’s extremely high body mass index. Two plates were utilized to achieve stable fixation of the glenoid neck fracture. Following a 1 year follow-up period, complete fracture union was successfully attained, resulting in a constant score of 79.ConclusionsThe most accurate radiographic indicators of these fractures are a superior fracture line located laterally to the coracoid process, a small inferior spike, and an elevated glenopolar angle. The only tendon attached to the glenoid is the long head of the triceps, making these fractures unstable; therefore, surgery is required in the majority of instances. The small size of the fractured component makes stabilization more difficult. Overall, anatomical scapular neck fractures are extremely uncommon and distinguished from other scapular fractures by their unique radiological and biomechanical characteristics. This case highlights the challenges encountered when managing scapular fractures in patients with morbid obesity. The delayed surgical intervention and the choice of surgical approach tailored to the patient’s specific anatomical and physiological considerations proved to be effective in achieving a favorable outcome.

Introduction. According to various studies, limb injuries caused by combat trauma account for 44% to 70% of all injuries to musculoskeletal system. Objective. This study aims to analyze shoulder girdle injuries in patients with combat-related surgical trauma who underwent surgical treatment. Materials and Methods. A retrospective analysis was conducted on 733 patients with combat-related surgical trauma of the limbs, including 378 patients (51.6%) with upper limb injuries and 355 patients (48.4%) with lower limb injuries. All patients received inpatient treatment at the Department of Severe Skeletal Trauma of the State Institution «Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine» from August 1, 2022, to December 31, 2024. Results. During this period, surgical treatment was performed in 63 patients with shoulder girdle combat-related surgical trauma, accounting for 8.6% of all limb injuries and 16.7% of upper limb injuries. The mean age of patients was 34.7±8.1 years. By injury type, gunshot wounds were observed in 35 patients (55.6%), mine-blast injuries in 13 patients (20.6%), other injuries in 8 patients (12.7%), shrapnel wounds in 4 patients (6.3%), and road traffic accident (RTA) injuries in 3 patients (4.8%). Fractures were classified into three groups: fractures and dislocations involving the clavicle in 28 patients (44.4%), scapular fractures in 17 patients (27.0%), and combined fractures of the clavicle and scapula in 18 patients (28.6%). Bone defects were observed in 43 patients (68.3%), with a mean defect length of 4,7±3,8 cm. Gunshot wounds to soft tissues involving shoulder girdle muscles and tendons were found in 54 patients (85.7%). Nerve injuries were diagnosed in 14 patients (22.2%). Major vascular injuries requiring surgical intervention, according to accompanying documentation, were found in 3 patients (4.8%). Conclusions. The analysis of combat-related shoulder girdle injuries demonstrated a high incidence of multi-structural injuries, particularly among working-age males (96.8%), requiring complex surgical interventions and prolonged rehabilitation. The most common injuries were fractures of the clavicle (44.4%) and scapula (27.0%), along with soft tissue injuries involving muscles (85.7%) and nerves (22.2%), which significantly complicate treatment and rehabilitation.

Fracture of the scapula is a rare injury in adolescents. The most common etiology is a motor-vehicle accident or another type of high-velocity blunt trauma. There is a high prevalence of associated injuries, many of which may be life-threatening. Operative treatment has been recommended only in the case of a displaced fracture of the glenoid neck or step-off within the glenohumeral joint. We report an additional operative indication: a fracture of the body of the scapula with penetration of the thoracic cavity by a fracture fragment. Our search of the literature did not reveal any previous report of this injury. A thirteen-year-old boy was struck by a dump truck while riding a bicycle. He lost consciousness and was hypotensive at the scene of the accident. A pneumothorax was diagnosed on arrival to the hospital. After endotracheal intubation and placement of a chest tube, the patient was transferred to the University of Missouri Hospitals and Clinics for definitive care. Physical examination revealed bilateral subcutaneous emphysema palpated over the anterior chest wall, multiple abrasions, and contusions about the thorax and the left upper extremity. A large hematoma was noted in the area of the symphysis pubis. Blood was noted at the external meatus. Orthopaedic examination revealed swelling and contusion about the posterior part of the left shoulder with no palpable osseous instability. There was a smooth range of motion, without crepitus, to 90 degrees of abduction. A full passive range of motion of the shoulder was not attempted, but the elbow and the wrist had a full, smooth passive range of motion and the vascular status of the extremity was intact. As the patient had been pharmacologically paralyzed at the referring hospital, a full motor and sensory examination was not initially possible at our institution. The records from the initial examination did …

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Background and AimsA 50 year-old male, ASA II has had suffered high energy blunt thoracic trauma from a road traffic accident presented with left-sided thoracic and upper limb trauma. On...

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Although the coracoid process seems to play an important anatomical role, there are few reports concerning fracture nonunion of the coracoid process (CN) and its disorders. Therefore, there is no widely accepted standard for the treatment of CN. PubMed and Scopus were searched using "scapular fracture" and "coracoid fracture" as search terms. The inclusion criteria were English full-text articles concerning coracoid fracture, and articles that described patient characteristics and presented appropriate images. The exclusion criteria were descriptive cases, and cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using Ogawa's functional classification, with Eyres' anatomical classification used as a supplement when necessary. Twenty-nine patients (26 men, 3 women) with 30 CN were identified. Nine CN had a predisposing factor such as seizure disorder and renal osteodystrophy. The fracture types were 12 Ogawa type I and 18 type II. Concurrent shoulder girdle injuries at the time of initial trauma/accident were varied. There were six cases of double disruption and two of triple disruption of the superior shoulder suspensory complex (SSSC), all of which had Ogawa type I fracture. Only six CN were isolated. The most frequent cause of CN was oversight by the previous physician (n = 11), followed by conservative treatment (n = 7). Although 12 patients with 13 CN had symptoms attributable to CN, most of these symptoms were insignificant. Although the acromioclavicular dislocation or CN persisted in eight patients, these residual abnormalities did not significantly affect the outcomes. Physicians treating CN should recognize that CN itself is frequently asymptomatic, and a satisfactory outcome is achieved solely by treating the concurrent injuries, even if CN remains. When CN is suspected to produce symptoms, the physician must then determine the mechanism by which the symptoms are produced, and select a treatment strategy. V.

Introduction: Otolaryngological trauma is prevalent in road traffic accidents (RTA), with or without multiple organ injuries. Objective: The aim was to report the number and pattern of otolaryngological injuries in cases of road traffic accidents (RTA) and their outcome. Methodology: A prospective study over one year of cases of RTA was done. The pattern and outcome of the otolaryngological and facial injury was recorded. Result: Out of 90 cases, 69(76.66%) were male, 21 (23.33%) were female. The mean age was 32.33 ±13Yrs.The mean time of presentation to emergency was 16.24 ±19.61hrs. Motor vehicle accident was more common, 75 (83.33%). Multiple injury was found in 68(75.55%) cases. Among 89 cases with ear problem, common complaints were hearing loss, 20(22.47%), otalgia, 17(19.1%) and laceration of pinna 13(14.6%). Ear complications were seen in16 (17.97 %) cases . Among 55 cases of nose/face injury, common presentation were epistaxis, 20 (36.36%) and nasal bone fracture, 12 (21.81%). Nasal complications were found in 8 (14.54%) cases. In 32 cases of neck/throat trauma, laceration was found in 11 (34.37%) cases. 4(12.5%) cases had undergone tracheostomy. Complications (stenosis and hoarseness) were found in 6(18.75%) cases. Patients who required admission were 81(90%). Conclusion: Motor vehicle accidents were more common. It was commoner in male. Ear was most commonly affected by injury and complications. The complication of nose and neck/throat was associated with prolonged admission.