Fracture

Scapula Fracture

Rare fracture (< 1% of fractures). Often associated with high-energy polytrauma. Conservative treatment in 90% of cases.

The scapula fracture is rare (< 1% of fractures) because this bone is well protected by surrounding muscles. It typically results from high-energy trauma (road accident, fall from height) and is often associated with other injuries: rib fractures (50%), pulmonary contusion, clavicle fracture, brachial plexus injury. The body and spine of the scapula are most commonly affected. Glenoid fractures (intra-articular) require surgical evaluation if displacement > 5 mm or articular step-off. 90% of scapula fractures are treated conservatively.

Characteristics

  • Posterior shoulder pain after violent trauma. Posterior swelling and difficulty mobilizing the arm. Often masked by associated injuries in polytrauma patients.
  • AP radiograph and scapular Y view. CT scan essential for glenoid fractures (articular assessment), acromion and coracoid process fractures. 3D reconstruction for surgical planning.
  • Always look for associated injuries: ipsilateral rib fractures, pneumothorax, clavicle fracture (floating shoulder), brachial plexus injury, vascular injuries.
  • Glenoid fractures: intra-articular. Displacement > 5 mm or articular step-off > 2 mm = surgical indication (arthroscopic or open fixation). Risk of post-traumatic glenohumeral instability.

Medical and surgical management

  • Body and spine fractures (90%): conservative treatment. Arm sling for 2-3 weeks, early mobilization. Functional recovery generally excellent.
  • Glenoid fractures with displacement: open reduction and internal fixation (screws, plates) to restore joint congruence and prevent post-traumatic arthritis.
  • Floating shoulder (clavicle + scapula fracture): surgical fixation of the clavicle to restore suspensory mechanism. Scapula fracture treated conservatively.

Physiotherapy rehabilitation

  • Early mobilization from day 3-7: pendular exercises, passive mobilization in flexion and external rotation. Gradual abduction from 3 weeks.
  • Rehabilitation of scapulothoracic function: gliding of the scapula on the thorax, scapulohumeral rhythm restoration. Strengthening of serratus anterior and trapezius.
  • Progressive strengthening from 6 weeks: rotator cuff, deltoid, scapular stabilizers. Proprioceptive training in different positions.
  • Return to full activities at 3-6 months depending on fracture type. Progressive reintegration of contact sports and high-demand activities.

Average duration

6 to 16 weeks of rehabilitation

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.