Scapular Fractures, types and treatment - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes scapular fractures and scapular fractures surgery .
Scapular fractures are typically a high energy injuries with an increase in the injury severity score (ISS).
50% of scapular fractures involve the body and the spine of the scapula.
10% of scapular fractures involve the glenoid fossa.
Associated Condition:
• 80-70% occur with associated injury.
There is a high association with rib fractures.
Head injury
• Head injury
• Ipsilateral upper rxtremiy injury
• Pulmonary contusion ‘pneumothorax
• Hemopneomothorax
Isolated scapular injury is really s marker for injury to the chest region .
Need to admit these patients for the pulmonary consultation, there is about 10% neurovascular deficit occurs in about 10%, injury to the scapula can be n=mii
90% of the fractures involving the scapula are nondisplaced or minimally displaced, and the treatment of these fractures is usually nonsurgical.
Most scapular fractures are treated conservatively.
Even if the fracture was moderately, treat conservatively y, treat the patient with a sling.
Patient with a sling, do Codman pendulum exercises for 2 weeks and then advice the patient to do active and passive range of motion.
Classifications of scapular fracture: based on the fracture location:
- Extraarticular fractures:
1- Acromial fracture: fracture will probably need surgery.
2- Coracoid fracture: occurs proximal to the CC ligament, it is usually associated with other injuries to the superior shoulder suspensory complex (SSSC) and it may need surgery.
3- Scapular neck fracture/ Clavicle fracture: management of these fractures is controversial; most of them are treated conservatively, even if the fracture is moderately displaced.
Treatment:
- Most of the treatment is sling and early range of motion.
- Give the patient a sling
- Send the patient to therapy
- Do progressive range of motion.
- Union of the fracture will occur in about 6 seeks with little or no functional deficit.
Surgical indication:
- The goal of the surgery: treatment is to achieve shoulder joint stability and to restore the rotator cuff function.
- Do surgery when there is involvement of the glenoid cavity more than 25% with humeral head subluxation.
- Or if you have intraarticular fracture with step- off more than 5 mm gap within the joint.
- For the neck of the scapula: do surgery if there is more than 40° of angulation, more than 1 cm of translation or if there is excessive medialization of the glenoid.
- What is the approach you use???
- The approach is based on the major fracture fragment displacement.
• Anterior approach for anterior rim fracture
- Such as bony Bankart fracture: fracture of the anterior- inferior glenoid.
- Avoid injury to the axillary nerve.
• Posterior approach:
- Is usually done through straight posterior approach or a modified judet approach.
- The straight posterior approach is used through a transverse incision over the spine of the scapula and you detach the posterior deltoid, entering through an interval between the teres minor and the infraspinatus muscles, this approach is used for posterior glenoid rim fractures or for fractures along the lateral boarder of the scapula.
Injury to the posterior shoulder suspensory complex:
Some people call that injury the floating shoulder because the glenohumeral joint is without attachment to the rest of the skeleton and others refer to this injury as a SSSC injury.
You need to decide if that injury is stable or unstable, unstable injury will probably need surgery.
Typically it is a scapular neck fracture plus clavicle fracture and because to plate the clavicle than to fix the scapula, then in the past the treatment of the floating shoulder was: ORIF (open reduction, internal fixation) of the clavicle then evaluate the scapular fracture usually by a CT scan, but they found that the sling equivalent outcome or even a superior outcome to preforming surgery.
So there was no support for surgery, they came to the conclusion that surgical stabilization only needed with specific indications to that fracture, it means: if the clavicle fracture meets the criteria for fixation, then fix it, if the glenoid meets the criteria for fixation, then fix it.
Scapulothorasic dissociation:
Is another injury of the scapula, it’s a lateral displacement of the scapula and soft tissue injury with neurovascular injury; it is similar to a closed forequarter amputation.
The scapula is torn and moves laterally, when it moves laterally, there may be a fractured clavicle distracted or AC joint injury or sternoclavicular injury.
The x-ray will show you the lateral displacement of the scapula, check the patient carefully, the subclavianartery and the brachial plexus could be injured, and the brachial plexus is torn first before the artery, so there is more brachial plexus injury than the arterial injury.
The outcome for the patient will depend on the neurological status of the patient.

[@successstreet7901]

Thanks a lot..complete your success..very beautiful explanation..actually i got more benefits with these educational videos..allah bless you Dr

[@moe9044]

Shattered my scapula in motorcycle accident a year and a half ago. Got a couple plates and lots of screws. Don’t think I’ll ever have the same range of motion thanks for this video!

[@bone_thuggz6969]

I also recently was involved in a motorcycle accident and my scapula was fractured. I am hoping that it will heal on its own , because I’m leaning towards not agreeing with plates and screws. I’ve heard that it’s pretty painful after that plate surgery.

[@rrf6747]

I fractured my scapula and broke my collar bone and 4 ribs in 2016 motorcycle accident seemed to heal up fine but had a dropped shoulder two weeks ago I injured it at work been in pain and stiffness ever since stiff neck from hell haven't seen a doctor yet but considering it

[@gearoftones8585]

I fractured my scapula back in 2008 after a large fall, among other breaks as well as a hip fracture and collapsed lung. The scapula fracture has never ever healed properly and I still have pain in that area to this day

[@daschundloverable]

+nabil ebraheim Thank you Doctor Ebraheim. Due to being tortured 8 times back in '86, I have many orthopedic and neurological problems. I was assaulted in '94 and in a coma for 29 hours. My left shoulder was dislocated in '86, all the muscles were ripped (adhesive capsulitis was worked out about 8 years ago.........bubble popped), my rotator cuff was ripped and when I was 52 with insurance was told by an ortho that they do not do surgery on rotator cuffs after the age of 50. My left shoulder is higher than my right one and is prolapsed. (I have not even gotten to the point of mentioning that to a doctor and only one noticed it). Also due to a very high impact fall about 11 years ago, after seeing 4 orthos, the first 2 only doing x-rays, the 3rd one doing an MRI, only came up with a contusion due to not having dye, finally I was given an arthrogram on my right hip. There it was determined that I had tabular? tears and a cyst. I have very, very limited range of motion with my arms. Difficulty walking with my right leg and hip. I also believe I fractured my femur during that fall. I am getting no help. Pain is uncontrollable. I am seeing my 5th ortho today that I feel we are taking 3 steps and 7 years back, because he ordered an MRI and x-rays for my hip. I just don't know what to do anymore. My hands no longer work. They are numb and tingle. I drop things all the time. Am not supposed to life more than 3-5#'s; but I live alone and that is impossible. I also have osteophyte complexes (diagnosed 10 years ago) at C6&7 and am wondering if they have since grown to C-8 and that is the reason for the loss of the use of my hands. I know that I am all over the place with my medical history, but any advice would be very much appreciated.Love your videos. I thank you for them.

[@tonyporter4132]

Oh my god you are pretty unlucky man, did you ever get your muscles reattached, also if you try seeing a chiropractor they might be able to help you with your hip, spine and shoulder Injuries.

[@ReggieT98]

Thank you.

[@christianduque7857]

Im from philippine, i have a communuted scapula fracture with no significant changes in degree of displacement and complete angular clavicle fracture within middle 3rd right clavicle with minimal formation of callous i read the result of my ct scan today it is of if im not undergoing surgical operation cost of lacking of money for the operation

[@behappywithkuhu3229]

@christian Duque how r u?plz reply..me too suffering with the same

[@frontlinemedia4270]

What r the symptoms of a brachial plexus injury?

[@tonyporter4132]

Is that on your bicep, what is that.

[@f.rjustforeducationfree507]

Thanks 👍

[@wwebeko]

Can u put pics of people with the same fracture as u say on the video, so we can see how it looks like on a person? Thanks for your videos!!

[@nickvdschouw3569]

im currently having my left scapula fractured. but besized little swolen lat, trap and delt there is hardly anything to see

[@Oakleaf700]

My son has a broken scapula and ribs and from the exterior it looked horrendously grazed, he hit head too, thank goodness he was wearing a helmet [bike jump injury] I do think had he not had such a good lid, his head would have been injured..the helmet needed replacing.

[@behappywithkuhu3229]

@@nickvdschouw3569 how r u now

[@nickvdschouw3569]

@@behappywithkuhu3229 fully recovered , no aftermath problem or so

[@behappywithkuhu3229]

@@nickvdschouw3569 how long it take to recover fully?

[@ghofranmk1992]

is Scapula fracture one of the most common fractures seen in the Emergency Department , or not ? please I have to know for my exam

[@pixiepia72]

No

[@briankennedy5697]

It’s only one percent of breaks

[@bone_thuggz6969]

My doctor said it’s a very very hard bone to break so it’s not very common. It is seen more in motorcycle accidents.

[@muhammadaryaan3463]

I have Scapular injury with the high speed riksha accident 5month before but still not recover plz do me favour

[@Oakleaf700]

Have you had treatment at a hospital?....Shoulder injuries are notoriously slow to heal, [usually falls from bikes or horses] and can indeed take almost a year to heal...the soft tissues are what take so long to recover [I am not a doctor, just know people who have had broken shoulders/scapula] Hope you can get some physiotherapy exercises that you can do [this is really all one can do to strengthen the injured soft tissues.

[@behappywithkuhu3229]

Me too... scapular injury 4months back... suffering till now

[@natalijakeleminec9787]

@@behappywithkuhu3229 oh noo, I had broken collar bone and scapula, also soft tissue, 4 weeks ago. (Motorcycle Crash) I still cant lift my arm :(

[@behappywithkuhu3229]

@@natalijakeleminec9787 my surgeon inserted a plate with 06screw into my clavicle.... I was having a very bad injury... I m having pain in scapular region and clavicle also till now..

[@behappywithkuhu3229]

@@natalijakeleminec9787 u choose conservative treatment or surgical

[@geojor]

thanks Dr ...

[@annu6940]

Mera scapular pura fracture ho gya h or 3 ribs bhi crack ho gyi h. scapular ki bons ek dusre ke uper aagyi h. Pura scapular crack ho kr bons ek ke uper ek aagyi h.plz kuch btao..plz help me doctor ye kaise thik hoga. Surgery se ya none surgery se.

[@karanbhinder3174]

How is now

[@behappywithkuhu3229]

@AJAY KUMAR how r u now?

[@er.swadeepshambharkar1410]

Abhi kaisa hai

[@tonyporter4132]

I looked this up because how does one break a scapula I needed to know.

[@elias8294]

I broke mine when I crashed my motorcycle at highway speeds

[@tonyporter4132]

Soo what do they do put a sling on it or do they screw it in with plates and stuff. Also can you retract you trap muscles.

[@elias8294]

@@tonyporter4132 I didn't shatter the bone so I just had a sling on for 3-4 months. My recovery was pretty much 100 percent, I have full range of motion at the gym and have no problem doing shrugs, lateral raises, rows, etc

[@swaggerjacker1482]

I broke mine today going down my basement stairs. Was going to fast and my feet slipped out from under me and I landed right on the shoulder blade. Hurt like a mofo. For right now I’m in a sling. Orthopedic appointment Tuesday. Hoping to just use a sling and recover

[@elias8294]

@@swaggerjacker1482 the only lasting side effect I had was nerve damage. I have a numb sensation in my tricep. It can be annoying if I focus on it, but normally I don't even think about it.