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Question
13 y.o. with shoulder trauma (during basketball game). Arm held in adduction and exquisite scapular tenderness. Diagnosis?
Answer
Answer: Scapular Fracture
Scapular Fracture
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Uncommon (1% of all fractures)
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Extensive force required; high probability of associated injuries (pneumothorax, shoulder dislocation).
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5 types: body/spine, acromion, neck, glenoid, and coracoid
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Arm held in adduction and pain with shoulder movement; may mimic rotator cuff tear.
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Obtain X-rays (AP shoulder and lateral scapula) or CT (if displaced).
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Conservative management for non-displaced fractures; Orthopedic reduction for displaced fractures.
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Complications include post-traumatic arthritis or bursitis.
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NSAIDs are first-line analgesics.
References
Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. Mosby Year Book; 2010:573-574.
Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma. Mar 2006;20(3):230-3.